Trust failed to give necessary medication

What happened

Mr E's father went into the Trust's hospital from intensive care at another trust with complex conditions including meningitis, encephalitis and ventilator acquired pneumonia. Mr E's father remained very unwell and was transferred to a medical centre at yet another trust for a neurological procedure to relieve pressure on his brain a week later. He returned to the Trust to continue his recovery.

What we found

We partly upheld this complaint. On both of his admissions to the Trust (which occurred over weekends) Mr E's father was properly assessed and received the specialist input he needed. We did not consider that Mr E's father was adversely affected because he was admitted over a weekend.

Mr E's father had complex needs which affected his nutritional intake but we did not find failings in the nutritional support provided by the Trust.

There were failings in the medication given by the Trust. Because of problems eating, Mr E's father did not receive thyroid medication he was prescribed and he missed important anti–seizure medication for five days. While Mr E's father was not harmed by the lack of thyroid medication, he had a seizure as a result of missed medication and the seizure resulted in aspiration pneumonia.

Our investigation also identified failures in record keeping at the Trust and our investigation was delayed when the Trust lost key documents, which it later found.

Putting it right

The Trust apologised to Mr E's family for the incomplete prescription charts and the failures in record keeping.

It drew up an action plan that set out how it would stop the same things happening again.