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Sorry, this is a long one.
An End-of-Life relative came out of Hospice and went home 2.5 weeks ago. As they have less than three months to live they were granted funded 24-hour home carers. I am the next of Kin and have some Powers of Attorney (not health)
Early on they were given less morphine that prescribed because the carer thought you could not have slow release morphine and ora-morph.
This was repeated the next day by another carer.
Two days ago, it was done again. The Care company owner went to the house and re-wrote the drugs chart because it was a mess and was covered in post-it notes despite no changes in dosages since the return from the hospice.
Yesterday AM the normal carer did not notice the Morphine tablets were different (stronger) and administered a triple dose of Morphine.
An ambulance was called almost immediately and my relative is now back in the hospice and seemingly OK.
The Palliative care nurse has raised an incident report and has formally complained.
The Care team boss has tried to contact me as next of kin, I have avoided a 'chat' and have asked them via text to send me an e-mail.
So, the question; Should I make an official complaint and chase this up or leave it to the professional channels?
It's been a long few months and a tough last few weeks. I don't have much left in the tank and would rather spend the time/effort supporting the patient rather than having an argument with someone I don’t know.
I also fear the company owner will kick downwards and the individual carer will be punished. She was the main carer and got on well with the relative and I believe was let down by poor training/documentation.
Let the Palliative Care team handle it - it's been raised as an incident report and they can follow it up.
As you say, spend your time/effort where you feel it's of most benefit right now.
I don't know how to say this without sounding glib which is not my intention, but I would have thought it's likely that your relative won't have experienced any suffering at all as a result and in that context I don't think I would make a complaint.
Keeping diary notes of what happened can be useful for future reference and might also help to "park" issues while you have more pressing priorities.
Professionally, it sounds like the carers aren't fully trained/aware of the drugs and what's going on.
That's not to say they acted with malice or are 'dumb', but simply lack training.
you CAN have slow release, AND quick release (breakthrough) morphine.. this is palliative care basics.
And not reading teh tablet doseage COULD have ended badly - thankfully it didn't.
I'd certainly raise these 2 simple concerns with teh care agency, in order to get the correct training for the staff.
DrP
Thanks for all the replies so far, they seem to mostly echo my thoughts.
Re;
I don’t know how to say this without sounding glib which is not my intention, but I would have thought it’s likely that your relative won’t have experienced any suffering at all as a result and in that context I don’t think I would make a complaint.
As you say, they were not suffering, but I was told that their breathing rate could slow down to 2-3 breaths a minute and I think that could have had catastrophic results for them based on their health issues. Luckily it did not happen.
I work in this area.
Medication errors are very common, too common. Reasons are complex but it is still serious.
By law (in Scotland) the care organisation needs to self report medication errors to Care Inspectorate. I assume it is the same in England. So, between them self reporting and health colleagues also raising it it should be well covered.
If you want piece of mind, you can ask both the care company and health who they have reported the error to and what will be done to support staff to not make same mistake again. If you don't want to get involved (understandably) you could just ask Health for a copy of the incident report so you have piece of mind that it has been raised.
Some very second hand experience on this but when administering controlled drugs, which morphine is but I think it changes CD status based on formulation, I thought best practice was to have it witnessed by another person. Primarily to ensure the correct dose is administered but also to ensure it doesn't go walkabouts. Appreciate this may differ across care settings.
But yeah I'd say let the paliative care team deal with it.
Pretty sure carers that handle Morphine, have to have a higher level of qualification (NVQ3 as well as End of Life/Palliative Care training, and possibly someone to double check the dose is correct.)
So not your basic "started doing this 3 days ago" carer
My wife did this for 20 years
It’s been a long few months and a tough last few weeks. I don’t have much left in the tank
If its being dealt with then maybe just leave it. Save your energy. Good luck.
If Palliative Care are involved, they will investigate what happened, identify causes, and institute a plan to prevent recurrence, usually involves updating the home's staff as to correct procedure,and liaising with GPs and pharmacists to ensure local policies with regard to prescription and administration of controlled drugs is followed. If no direct harm has come to your relative , it is usually treated as a learning and supervision ,opportunity, not a witch hunt.
Sorry for the tangent. Wish I had known about the care funding for end of life. My Mum was whisked to a care home and we were never told we had that option. She died there but would have been nice to know the option to come home was available.
Nothing to add to this post but to ask how you and the immediate family are. It is a really draining experience without these added issues.
There are various help lines (plus STW) you can talk on if it helps. STW has helped me in a number of stressful times including one member (possibly former member (Fred Dibnah)) talking me out of a dead end place until 3am.
I am not suggesting or implying this is affecting you but worth checking those around you too.
Never been in this boat but I'd be parking it and leaving it to the care provider and "regulator" to sort and maybe ask to be updated on the outcome later.
I'd be focussed on the relative and the short term future (having been through the long term palliative care phase with a relative myself in the last 12 months).
as above ask for a copy of all reports and actions taken to protect other patients lives, mistakes happen, but covering up or ignoring mistakes/problems causes more mistakes/problems, remember dr shipman, people didnt report stuff.
Mrs llama, who is very experienced these matters:
Ring the local authority adult care team to report a safeguarding issue. Hopefully your family member is fine but there may be other people who are having the same experience and are not.