Date: 06 March 2017
The patient called 999 when he had stomach pain radiating into his chest and wanted to know why the crew would not take the patient to hospital. The paramedic arrived, back up was requested. The crew arrived and did not think the patient needed to go to hospital and contacted the surgery. The patient spoke to the GP and he prescribed Tramadol for the pain. The patient had a prearranged ECG the next day. It was confirmed the patient had had a heart attack.
The complaint was investigated by an Area Clinical Lead. All documentation completed for the patient was reviewed along with Computer Aided Dispatch (CAD) record for the call. A detailed assessment took place. This was well documented and showed that during the assessment the paramedic identified the patient was suffering from pain in the upper abdomen and that the pain was radiating up into the chest and neck, similar that the patient had reported as having intermittently over the last year.
The patient reported that the pain was more significant than before hence the call to 999. Following the assessment, pain relief was provided along with anti-sickness medication. It was identified that the effectiveness of the pain relief was not re-assessed.
As the assessment continued the paramedic identified that the patient had an ongoing history of upper gastrointestinal problems and was undergoing an investigation for this with his GP. The patient had been prescribed medication by the GP for this, previous to the ambulance attendance. They also noted that the patient was due a follow up appointment the next day. The assessment carried out by the paramedic concluded that the likely cause of your pain was due to an exacerbation on the current and existing condition. From review of the Patient Care Record it appears the clinician’s assessment did not identify any immediate concerns that the pain the patient was suffering was cardiac in origin.
It was identified the paramedic's actions were appropriate, based on there being a clearly documented assessment process that was undertaken and that the assessment concluded that the exacerbation of a pre-existing condition was the cause of the current symptom presentation. The paramedic rightly elected to seek advice and guidance from a more senior health care professional, one who would have access to the patient medical records and together they decided that the best course of action was a review by the patient’s GP.
- Lesson learnt / action taken:
Based on the documented assessment and findings of the investigating manager, to seek senior advice was reasonable. It was recognised that certain areas, in particular in relation the ongoing care advice given to the patient and what to do in circumstances if his condition did not improve or were it to deteriorate fell below the Trusts expected standards. For these elements apologies were provided and assurance that these matters were raised with the attending clinician to ensure they are aware and are able to undertake a reflective practice process to improve their standards of care.
- Date:01 January 2017