NHS Borders has apologised to the family of an elderly woman after accepting that she did not receive “appropriate care” in the Borders General Hospital before her death.
The health board was responding to the findings, published last week, of the Scottish Public Services Ombudsman (SPSO) which investigated and upheld two complaints by the patient’s daughter.
Among a raft of recommendations, the watchdog has ordered NHS Borders to review the care and treatment provided in the hospital’s 30-bed medical assessment unit (MAU) “to ensure timely care is provided to those patients at risk of rapid deterioration”.
The health board has also been told to share its findings about record-keeping, blood testing and blood pressure monitoring with the medical and nursing staff who were involved in the care of the patient – referred to in the SPSO report as Mrs A – during her stay in the unit.
The watchdog also wants “more detailed information” on a pilot project set up by NHS Borders to improve communication with family members to show that this been implemented throughout the hospital.
The report recounts how Mrs A’s daughter, referred to as Mrs C, had complained that her late mother did not receive appropriate care after she was admitted to the BGH.
Mrs C had also complained that the family was not informed in a timely manner when Mrs A’s condition signficantly deteriorated.
At the outset of the SPSO investigation, the health board accepted that staff had failed to inform the family about Mrs A’s worsening condition when it was known and had apologised.
But NHS Borders claimed care had been delivered to Mrs A “in a timely manner”.
However, after taking independent advice from a consultant geriatrician, the SPSO has concluded that the patient did not receive appropriate care in the MAU.
“We identified evidence of poor record-keeping and that there was undue delay in identifying that Mrs A was significantly unwell,” states the ombudsman’s report.
“There was a delay of six hours in nursing staff checking Mrs A’s blood pressure, which is contrary to national guidance.
“We considered that blood tests could have been carried out sooner and that there was several hours’ delay in staff taking these abnormal blood results into account after they were reported.
“We also noted there was a four-hour delay in the family being informed that Mrs A’s condition had significantly deteriorated.”
Responding to the report, Andrew Murray, the recently appointed medical director of NHS Borders, said: “We fully accept the recommendations from the SPSO and recognise that the care provided to Mrs A was not of the standard that we expect for our patients.
“We are deeply sorry for this and have apologised to Mrs A’s daughter.
“I can confirm that the actions from the SPSO report have been implemented and the learning from Mrs A’s experience and that of her family is being used to make improvements.”