Elderly man not given ‘time-critical’ medicine during three-day stint in A&E
Only eight of 18 doses of Parkinson’s medication were provided to the patient on time.
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Your support makes all the difference.Concerns have been raised over patients facing long waits in emergency departments not being given time-sensitive medication after a man was left unable to swallow due to missed medicines.
An elderly man was sent to a hospital’s A&E after a routine hospital appointment but ended up spending three days in the department.
The 85-year-old had Parkinson’s disease and he required medicine at various intervals to control symptoms.
No patient who enters an emergency department should fear their health will be put at risk because they are unable to access their regular prescription when they need it
During this time in the emergency department, the man should have received a total of 18 doses of his Parkinson’s medication, but seven doses were not given and three doses were given late, according to a new report by the Health Services Safety Investigations Body (HSSIB).
The report, which does not divulge the name of the patient or the hospital he was treated at, highlights how the man was advised to go to A&E during a routine appointment after he complained of back pain following a fall at home the day before.
After 52 hours in A&E, he was finally admitted to a ward where his Parkinson’s symptoms deteriorated and he lost the ability to swallow, the HSSIB said.
He died four weeks later.
The causes of death listed on the man’s death certificate were a severe chest infection, Parkinson’s and frailty of old age.
The HSSIB report highlights how the man spent most of his time in A&E on a bed in a corridor because of demand on services.
Corridor care can cause problems for emergency staff because there is “limited opportunities to store medication brought from home”, the authors said.
They highlighted how there was no function to automatically alert staff that he should have received time-critical medication.
And staff were not able to check prescription information with the patient’s GP practice or Parkinson’s specialty team outside of working hours.
A&E staff also received contradictory information about the dosage of medication required from the patient’s record and his son.
Staff took the GP information “as the most accurate record, but the information it contained was incorrect”.
Investigators found that there were “no defined roles or responsibilities in the emergency department to ensure patients who required time-critical medications were identified, and medications prescribed, as soon as possible”.
The HSSIB warned that “patients who need medications can suffer harm if these are not provided” as it called on health bodies to make sure they are adhering to expert guidelines on time-sensitive medications for patients.
When patients are in the emergency department, it is crucial that, alongside any emergency treatment needed, medication they require for other conditions is prioritised
The latest performance data for the NHS in England shows that 49,592 people had to wait more than 12 hours in A&E departments in October from a decision to admit to actually being admitted, the third highest monthly figure since comparable records began in 2010.
Deinniol Owens, deputy director of investigations at the HSSIB said: “When patients are in the emergency department it is crucial that, alongside any emergency treatment needed, medication they require for other conditions is prioritised.
“The case we examined during this investigation was a sobering example – if patients do not receive medication for their Parkinson’s it can make them seriously unwell, and doses not being given on time increases the risk of harm and reduces the effectiveness of the medication.
“It is distressing for patients and their families, and in this case the family felt they were not always listened to even though they communicated his needs and emphasised how important the correct timing of the dosage was.
“Our investigation makes a number of important findings in relation to how time-critical medications are considered in emergency departments.
“We are sharing this at a national level to prompt providers to look at on how they administer critical medication, in a busy and challenging emergency environment and how they ensure patients receive medication in a timely and safe way.”
Commenting on the report, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said: “What is detailed should serve as a call to action for all emergency department clinicians.
“No patient who enters an emergency department should fear their health will be put at risk because they are unable to access their regular prescription when they need it.
“Asking patients if they take any time-critical medication, and when their next dose is due, should be one of the questions every clinician asks.
“This simple inquiry becomes increasingly pertinent given the backdrop of the extremely long A&E stays more and more people are having to endure. In this tragic case – a shocking 52 hours.
“Today’s HSSIB report should be essential reading for all emergency medicine clinicians, and the Royal College of Emergency Medicine will continue to work to raise awareness of time-critical medication to help ensure tragic incidents such as those it details cannot, and do not, happen again.”