AIBU to very angry with GP and nurse

[Sunnyday1203]

So dad has dementia and has a memory span for about 10 mins. He recently had a fall and his GP did a home visit and prescribed Pain killers, he was bed bound and lived on his own. He was left with a pack of pills and took 18 Paracetamol l in 12 hours, so ambulance called he refused to go to hospital. (carer found him) His GP knows him well, just can't believe he could be so thoughtless. Fast forward dad now in hospital and turns out he has a fractured Coccyx, he has been in 2 weeks and about to be discharged to a home, I was checking through is bag and found a box of different pills and did not recognise them, so did a bit of research and very very strong meds, on closer inspection these meds are not my dads. If he had taken then thinking they were his he would have died. Nurse said sorry when I questioned here, but really AIBU thinking they are trying to bump him off. I am appalled and worried that this can happen

It is simple GP was called out, prescribed painkillers that were delivered to my dad and left by his side

But who called the GP? Who took in the pills when they were delivered and left them with your dad?

So it was't the GP at fault.
He simply prescribed some pills.
He may know your Father, he is not however, responsible for your Father's safety.

So it was't the GP at fault.
He simply prescribed some pills.
He may know your Father, he is not however, responsible for your Father's safety.

Umm actually the GP is responsible for her Father's safety!
It would have been bad enough if it had been some unknown out of hours Doctor, but for the actual GP who knows the patient and has full access to the records - it was unacceptable.

Now we know Doctors and the NHS are under stress - so might even understand how mistakes can be made in the "heat of the moment" - but that doesn't excuse them or mean that the OP shouldn't complain.
In both cases there is obviously a lapse in procedure - a complaint could help for the procedures to be changed and prevent more serious consequences in the future.

Despite all the awareness raising around dementia, the message doesn’t seem to get through to a lot of health care professionals and their support staff.

It amazes me that it is the case. The vast majority of people being treated by the NHS are over 65, so it goes that a number of these will have dementia.

Umm actually the GP is responsible for her Father's safety!

But what has the GP done wrong? The op doesn't say he gave the pills to her father. He wrote out a prescription which was delivered later. Someone else must have been there to call the gp, let him in, take in the pills when they were delivered and give them to op 's dad.

The GP responded to a call, made a medical assessment and prescribed appropriately. If your Dad literally has a memory span of 10 mins he cannot possibly be 'living independently' and the fact that you have referred to a carer suggests he is not. I think the carer/family members who are supposed to be keeping him safe (and ? even phoned the GP in the first place) perhaps need to reflect on the situation too. If he's being left alone long enough to take a staggered overdose then who knows what other mischief he could be getting himself into (hope he doesn't have a gas hob!).

It's not unreasonable to suggest that if he is considered safe to be left unsupported/supervised for 12 hours (which is what you're suggesting that you and the carers are happy with) then he probably should be considered to be safe enough to not take the whole box of drugs in one go.

As a slight aside, it's also interesting that the paramedics felt he had capacity enough to make the decision to stay at home (rather supporting the GPs decision that it was safe to leave the drugs with him). Paramedics, as a group, are very risk averse and, knowing that paracetamol overdose is potentially life threatening, will have had to be well convinced that his cognition was adequate to weigh up the risks and benefits of non-admission before leaving him at home.

Hope that your dad has an increased support plan in place for his discharge to prevent similar (or worse) happening again.

My mother of 87 had a stroke and was taken to hospital where she was given morphine. When she became disorientated and upset they gave a lot more morphine and she died. My father had COPD and they put him on the Liverpool thing, starved him of food and water until he died. He wasn't ready to die. Didn't want to die. Deprivation of in particular fluids is a very painful way to die. I had fluid removed from my right lung which was very painful, especially as it should have been my left lung. My grandfather was a doctor and grandma was a nursing sister but I now have no faith in any of them today especially a I have a heart condition, have been having a lot problems since having sepsis and kidney failure in M,arch, and the arrogant cardiologist refused me an appointment without even checking me or giving me a reason. I now have no faith in any of them.

So was it a hospital nurse or the carer who put the strong pills in your dad's bag?

This sounds like more of an issue with your dad's health in general. I think he needs more care.

I agree my dad needs to be in a care home now, I have had endless meeting with the SW's and care teams and they keep saying that he should have freedom and try to support him but carers are not really trained to look after dad. Sometimes he presents well so unless you know him it takes a while to realise he has dementia. After this last episode, I am insisting he goes into a home even if it is for 6 weeks. Only this pm SW said he maybe could go home alone, he can't even walk to the bathroom atm ffs. I agree with many others that dementia is not really understood by many people working in hospitals. Emma it was a qualified nurse who put the pills in my dads bag. Over60 I am sorry to hear what you have experienced, that is appalling

These are two separate issues.

The ward nurse who put some other patients medication in your Dad's bag has made a grave and potentially fatal error and I would make a complaint. It appears she didn't follow correct procedure in making sure medication was provided to the correct patient.

The GP who did a home visit and prescribed paracetamol did nothing wrong. He didn't give the paracetamol to your Dad he gave a prescription to the pharmacy. The pharmacy delivered or someone collected on your Dad's behalf and the pills ended up with your Dad. The fault there is insufficient care in place. An arrangement should have been made with the pharmacy for medicines to be collected by carer / family member and they should have been responsible for keeping these away from your Dad and administering the right dose. It sounds as if your Dad didn't have enough care in place.

You need to make a complaint the the hospital. That is absolutely a sackable offence for the nurse.

At the trust I work for, the patients only get take home meds at the point of discharge and they're checked and double checked. How the hell did the nurse get hold of another patient's meds and put them in your dad's bag??? How many times has she made mistakes like that in the past, or will she make in the future?

You need to make sure that you present your dad's condition as what he is like on hist WORST day, regardless of how he presents on better days. Make sure they know the extent of the care he needs.

This is definitely worth a formal complaint. I’m really sorry what you’re going through with your dad; made worse by errors made by GP and nurse. The complaint will not help your father but may ensure safer practises for other patients. If he is being discharged to a home at least you have the comfort of knowing that further medication errors are now extremely unlikely.

Finding a home is a difficult business. Because he is hospital my dad case has been transferred to a different SW and she does not know him. I had to be very direct this morning when she suggested he go home to try living on his own again. This is his 3 rd time in hospital due to self neglect. He has carers going in twice a day but he will not allow them to do anything.

Sunny The social worker you are dealing with will be from the transfer team. Refuse to have him home, tell her that his home is not suitable for him anymore as he has become a danger to himself and his environment. I promise you that if you kick up a stink, it will get escalated.

With regards to his carers, this is very common and they cannot force him to do anything, all they can do is report it to get it logged - this is good for your dad as it builds up a picture of self neglect. Two calls a day is woefully inadequate for his present needs. You may have a fight on your hands but stick to your guns. Do you have power of attorney? You should think about it.

Good luck.

So the GP does his job and ends up with a complaint for doing his job.

to you and your dad. Dementia is a very difficult disease for everyone.
Definitely say his home is not safe for return and look round as many care homes as you can ASAP. Choose one that is friendly and bright and clean. They will be very experienced with dementia care and know how to keep him safe and comfortable.
Best of luck OP

If the nurse found the meds in his lockable cabinet or even just on top of it, would it be normal that she would be expected to scrutinise the meds box closely to make sure they matched the patient's name... even if he was in a single-occupancy room?

Do you have LPAs in place? Is your Dad self funding for care?

If so, find a good care home with a place and get him discharged to them

If he needs a funded place then sharpen your elbows and get tough. It is a lot cheaper for the local council to keep him at home even with carers going in 4 times a day (usually the maximum home care package and around £12-14k per year) than paying for a care home place (minimum of £24k a year, more for a nursing place.

He needs a full reassessment of his care needs and that can include the carers dispensing his medications from blister packs if required.

That can be done in hospital but you need to push and push hard

FWIW I’ve just had my Dad in hospital and discharged to a care home with likely vascular dementia - all with no input from Social Services. My mum remains at home with the maximum home care package that the council commission (4 x 30 min visits a day with two carers) and privately commissioned night sitters

The care costs are eye watering though - £44k pa for my Dad, £65k pa for my mum (night sitters are bloody expensive). And that doesn’t include general costs of running a house

I don’t think the GP did anything wrong but the nurse made a serious error. I would also ask the pharmacist who delivers your Dad’s medications what they suggest as they will be used to delivering to people living alone with dementia

The GP did nothing wrong.

G.P's are too quick to fob patients off to relatives especially the elderly. who are now rudely termed bedblockers, a drain on the NHS and benefit system even though they have worked hard all of their lives and contributed to the system. When they need it most they are let down. The wrong medicine is not a mistake it is negligence. All meds are che ked or should be checked when you go to the discharge lounge. They are supposed to check that the patient is not going home to an empty house and should contact relatives to say that the patient is being discharged and what time. It seems that there have been mistakes on all sides and all of them NHS. I feel for you and your dad. My aunt had dementia and ended up taking her day pills and night pills several times a day-yes, she died. We should look after our elderly and so should the NHS

I would imagine the nurse simply put all the meds that were locked in his cabinet/ pod into his bag. Quite often other people’s drugs can be left behind in them. As a new nurse I once emptied someone’s pod when they were changing wards and sent all the drugs upto the new ward without checking them, and some were not the patient’s. I was told off for that even though the patient was never at risk as patients’own drugs are never left with the patient. It was a good lesson for me to learn though and now Im very careful with discharging patients with meds.

It was very careless of her and she should have checked first. Some people do bring in drugs that aren’t on their regular prescription though. I would let the ward know, so all staff can learn from this, however I wouldn’t be after blood. It is an easy error to make when people are rushed. She may have been newly qualified.

head I am a little worried that you think this is an easy mistake to make, it could have been fatal. I am not after blood but this should be a serious concern for us all. My dad is being put at risk because people are not doing their job properly.

stop making excuses for doctors and the NHS. The wrong meds is not a mistake but negligence. Complain! You could have lost your beloved dad over this and no apologies from them would have brought him back. This happens too often. Fight your corner and your dad's as the next person may not be so lucky. I send you my best heartfelt wishes.

over thank you. This is my first experience of dementia and I am trying to do the best for my dad. The SW reluctantly is trying to find a home that will take him for 6 weeks, still trying to say he is safe to go home, ermm I think not. And asking his thoughts, which is a bit laughable as he does not have capacity to make decisions anymore.

A lot of easy mistakes can be fatal in nursing. I’m not saying it’s ok, it isn’t. However you said she was mortified. She is unlikely to make that mistake again and no one was harmed.