Am I right in thinking that for an A&E doc to assume a prescripton on system from a year ago is still valid is a very dangerous thing?

[Buda]

Bearing in mind the drug that he/she gave my mother yesterday has resulted in hallucinations, upset, confusion and the hospital wanting to put a tag on her ankle to stop her wandering off.

I am livid. Totally and utterly livid.

My Mum had a stroke last year and although it was mild with just her speech affected, she hasn't been right since. Neurologist wanted her admitted and as they could not get her a bed after 4 weeks she suggested admitting her through A&E. All arranged with promises from neuro that if too busy they would let my Dad know so as not to come that day. Dad and sis took Mum in on Tuesday. She was assessed and even the neuro registrar didn't know why she was there. She ended up on a trolley till Wed afternoon. She was totally fine in herself - my DAd and sis remarked on how strong she was being. When no bed was forthcoming they suggested she went home but she insisted on sticking it out. She was chatty to everyone and even helping people who were in a worse state than her.

She finally got a bed yesterday afternoon but my Dad got a phone call to say she was ver confused and they would give her something to help her sleep for a while. My sisters went up to see her last night and got such a shock to see her curled in chair fully dressed holding onto her bag. Refusing to get changed. Refusing food and drink. Nurses wanted to put a tag on her.

My sister phoned my other sister who immediately asked what she had been given. Turned out doc in A&E gave her a drug for alzeimers (which she doesn't have!) which had been prescribed a year ago but which she was taken off 4 days later as it was not agreeing with her.

I am so flabbergasted and annoyed I could cry. Mum is terrifed of hospitals and was being so brave in sticking it out in A&E as she really wants to get better. Am holding myself back from phoning consultant and tearing a large strip off her.

Will def be making a formal complaint once Mum is home though.

I'm sorry you and your Mum have been through such an awful experience.

It depends a little bit as to why the doctor prescribed the drug - did he do it because he thought it was current medication and he was continuing a regular prescription, or was he intending to start a new drug (though this seems unlikely - Alzheimers meds should not be initiated in A&E)?

If he thought it was an existing prescription, it depends what information he had access to at the time. Do you know where he got her medication history from? Do you know if they called the GP surgery/ did someone in your family have an repeat prescription list with them which still shows the old drug/ did someone have the old tablets with them etc? Establishing an accurate medication history on admission to hospital, especially in an A&E setting, can be very difficult. Often, when I've called a GP surgery for these details, the list of meds on the system is reeled off by the receptionist, and the last date a prescription was issued is often not given unless I specifically prompt for this information (sorry - not another pop at GP receptionists!).

If the information he had was clearly dated to show the drug had not been issued for a year, then yes, he should have taken this into account. However, IME, doctors don't necessarily have the time to look into a medication history in that much detail, especially if they are busy trying to diagnose and treat. I'm not trying to excuse what sounds like an error, but I would say that this kind of discrepancy happens a lot more frequently than anyone would like, and is usually due to the inherent difficulties in the process. Taking an accurate medication history is a skill which needs to be learned, and I don't believe doctors get very much training on this.

The NPSA (National Patient Safety Agency) and NICE recently issued some guidance about 'Medicines Reconciliation' on admission to hospital - i.e. good practice for ensuring that a patient's pre-admission drugs are confirmed and reviewed as soon as possible after admission. You can find some of their guidance here. This may be of use if making a formal complaint e.g. ask about the Trust's progress with the recommendations.

Your Mum sounds like a strong woman, and I hope she, you and your family are able to get through this difficult time, and come out of it with her feeling much better (not worse) .

The only other thing I would say is that at the hospital at which I work, some of the consultants use the Alzheimers drugs for other reasons i.e. they are giving it for unlicensed indications. One consultant has referred to them as 'chemical walking sticks', and uses them short-term as he believes it helps certain patients to recover.......well, I'm not entirely sure what his rationale is, we never quite get to the bottom of it. My point is the drug may have been prescribed for another specific reason, but you would have to check with the doctor about this.

Sorry, bit of a waffler!

Goodness, that's even longer than I thought!

Thanks for that reply JuwEggsm.

Mum is in Ireland so guidelines in UK not applicable.

We spoke to doctors yesterday and they have apologised. We had sent in her current medication and the current prescription. They just didn't bother to find out. It was essentially lazy doctoring in my view.

The frustrating thing is that mum was completely compos mentis when she went in. The staff promised my sister that they would give mum something to help her sleep on the Tuesday night. They didn't. So she was exhausted on Wednesday morning when seen by the doctor. Haven't ascertained yet if it was a general A&E doc or a neurology doc.

Thankfully as of yesterday afternoon she was 'back to base-line' in the words of the nuurology SHO I managed to speak to. I think they were a bit pissed of that I rang - suggested we nominate one family member to speak to them! I appreciate they are busy but if they actually did what they were supposed to do/promised to do/communicated to us we wouldn't have to hassle them for info!