Patient discharged herself from hospital because she was concerned about her care and treatment

What happened

Mrs S's GP referred her to the Trust's A&E department because she had serious respiratory problems. The specialist registrar saw her and diagnosed acute exacerbation of asthma, and noted that Mrs S wanted to go home. It was agreed that she should continue with the medication her GP had prescribed and would go back to the hospital the next day to make sure that her asthma was settling.

When she returned, she saw a respiratory consultant who thought that she had not improved enough, and recommended that she was admitted the same day.

In hospital Mrs S became concerned as she did not receive either her insulin for her diabetes or the steroids she expected. She discharged herself the next day but when she tried to leave, the staff called security, who tried to stop her from leaving without signing the self–discharge form. Mrs S refused, and left with a friend.

What we found

It was more likely than not that a consultant had said that Mrs S needed the steroid but then did not write the prescription. This did not have any long–term effect on her condition but it would have made her lack confidence in her care.

The Trust's response about Mrs S's insulin was unreasonable. It initially said that staff gave her the insulin, but later accepted this was not correct and staff had not given it to her. The Trust then gave a contradictory explanation of why staff did not give Mrs S the insulin.

There were also concerns about medicine reconciliation. If good practice is in place, staff prescribe the correct medications at the right dose and at the right time when a patient goes into hospital. But this did not happen, and Mrs B's insulin does not appear to have been prescribed throughout her time in hospital.

The Trust also said that Mrs S had refused steroid medication. This was not correct and the rationale for not giving it was unreasonable. This would have led Mrs S to feel anxious about her care and was an additional factor that led to her discharging herself.

Nurses on the ward were not aware that Mrs S had diabetes and she had to ask for insulin and for something to eat. But it is clear from the assessment unit records that Mrs S was diabetic and needed frequent blood glucose monitoring. Because of a failure in communication, Trust staff did not prescribe Mrs S's insulin and did not monitor her blood glucose until the evening.

If, as is established practice, ward staff had fully reviewed her medical and nursing record from the assessment unit, they would have seen that Mrs S had diabetes.

Mrs S chose to discharge herself because she was concerned about her treatment. The Trust said that security staff were called as Mrs S refused to sign a

self–discharge form, but this form is not required if a patient has mental capacity and decides they want to leave the hospital.

The care records show that nursing staff discussed the risks of discharging herself with Mrs S and that she had the mental capacity to decide to do this. Therefore, there was no need for security to be involved. This was inappropriate and added to her stress and anxiety.

Putting it right

The Trust wrote to Mrs S to acknowledge and apologise for its failings and for the impact that these had on her. It also agreed to develop an action plan to address the failings identified.