Decision Report 201507569

Summary

Mr C complained about the clinical treatment and nursing care received by his mother (Mrs A) at University Hospital Crosshouse, in particular that the board had not prevented Mrs A from catching hospital acquired pneumonia (HAP). Mrs A died while in hospital.

During our investigation we took independent advice from two advisers, a consultant in respiratory medicine and a nursing adviser.

The consultant in respiratory medicine noted that the clinical care given to Mrs A was reasonable. They said that given the nature and severity of Mrs A's condition, she was vulnerable to catching HAP and that the medical team caring for her took all necessary measures to prevent infection.

The adviser also noted that although '1A Pneumonia' was recorded on Mrs A's death certificate, the certificate should have referred to HAP. We therefore made a recommendation to address this.

The nursing adviser noted that there was no evidence of failings and that the nursing care and treatment provided to Mrs A was reasonable. We therefore did not uphold Mr C's complaints.

In their response to Mr C's complaints to them, the board accepted that some of the communication with Mr C and his family had caused confusion and misunderstanding. They apologised for this and took action to address this. The board also apologised that they had failed to offer spiritual support to Mrs A. We therefore made recommendations to address these issues.

Recommendations

We recommended that the board:

• consider whether there are any training requirements for the staff involved in relation to communication with patients and family members and whether there need to be internal guidelines in relation to communication;
• bring detail recorded on the death certificate to the attention of relevant staff and report back on any action taken; and
• provide copies of their spiritual care policies/guidelines.