hosp doc v local GP, conflicting decisions

[Mrs TP]

Oh the fun never stops in our house ...

After a 7 wk spell in hospital my mother-in-law was discharged just before Christmas and is going from strength to strength - hooray. One of her medical probs was blood clots on her lung and she was being treated with warfarin in hosp and now has a district nurse visiting her everyday to continue warfarin injections at home.

She told us today that the district nurse has not been for the last 2 days as my MIL does not have any needles left for the injections. Apparently, my MIL has to supply the needles herself via repeat prescriptions from her GP. Her GP says she does not need the warfarin and is refusing to re-supply needles but the hosp specialist has said she is to continue treatment.

What can we do?

She lives in Lambeth and is under St Thomas's.

[Strawbs]

I would have whoever your contact at the hospital is to call the gp ASAP and tell them in no uncertain terms what she needs and to tell them to do the prescription!! Until then surely the hospital can supply enough until she can get a script filled?

[Fuschia]

The injections must be heparin (clexane or fragmin) as warfarin is tablets. It is true that kings haematologists also can only prescribe a couple of weeks worth and gp then takes it over. The hospital sends a letter specifying what is needed.

The injectable blood thinners do, in due course, get replaced by warfarin which is much cheaper but requires more monitoring (blood tests weekly for eg)

I think the best thing to do is to call the hospital and get the consultants secretary, ensure a letter has been sent to the gp and get a copy then arrange an urgent gp appt. in the meantime, if she has been missing daily injections which are life-saving, sounds as if the hospital perhaps should check her over and prescribe again as a stop gap, if the gp isn't getting things sorted.

[Fuschia]

She must get the injection tomorrow. If she had a pulmonary embolism so recently, the blood thinners are essential.

I hope you can get it sorted out x

[Saffron]

If you haven't spoken to someone already, I would take her to the A&E today.

[Gidget]

Call the haematology dept. at St. Thomas's and explain what happened. They would have taken advice from one of their team if she had blood clots at the hospital. They should also offer to see her because she was treated there. Much better than going to A&E.

Would also call Southwark PCT and report the GP.

[Mrs TP]

Thanks all - a different district nurse called this am has taken over and has all back in control - phew.

[intexasatthe moment]

I think you should speak to the Team Leader to ask why this happened in the first place and what the protocols are to avoid it happening again - to your relative or to someone else .

The DNT is no doubt under pressure ( so all the more need to have procedures in place ) and I don't feel entirely comfortable criticising them ....but this kind of experience is far from rare and vulnerable people are put at risk by what IME is a system that often breaks down .

Poor communications between DNT and patients and surgeries ,lack of continuity of care ,Health Care assistants who are not properly supported or used in complex cases where greater knowledge/training is needed .

I have made formal complaints in the past and to a limited extent have found that things have improved .

[Pugwash]

Check what was in the Discharge letter which she should have got a copy of when she left the ward. GP should also have same copy but get a photocopy of your mother's to give to surgery

[Mrs TP]

Too many things happened over last 48 hours to detail. I phoned St Thomas's today, they told me to go in and pick up the injection kit, which I have done and a district nurse is going to visit and inject tomorrow. MIL is having oral warfarin as well so not such a huge panic (I didn't know this til today) and her last blood reading early last wk was within normal range but the hosp want to continue the injections until a second within normal range blood result within next few days.

Complaints lodged and me on to our next family trauma ...