Mrs A's dental problem was not diagnosed in A&E but later by an emergency dentist. But poor record keeping in A&E failed to show staff had made an error.
What happened
Mrs A had severe toothache and went to an emergency dentist, who gave her antibiotics. This did not relieve the pain and her face and neck began to swell, so she went to A&E (urgent care service, provided by Partnership of East London Co–operatives Limited). A nurse practitioner saw Mrs A and concluded that she had not been taking the antibiotics long enough for them to be effective. She gave Mrs A stronger analgesia and discharged her.
Mrs A's symptoms did not improve and her face and neck continued to swell, which affected her speech and eating. She went to another emergency dentist, who diagnosed Ludwig's Angina which is a type of skin infection that occurs under the tongue and is a very rare and serious condition. The dentist referred Mrs A directly to hospital, where she was admitted so staff could drain the infection. She had antibiotics at the hospital and surgery to remove a tooth.
Mrs A complained that the nurse practitioner in A&E did not take all her symptoms into account, and did not assess her properly. She says the nurse practitioner, along with a doctor she consulted, failed to recognise that her symptoms indicated she was suffering from Ludwig's Angina. She felt it was inappropriate for the nurse practitioner to discharge her home.
What we found
We partly upheld this complaint. There were some differences between Mrs A's and the nurse practitioner's accounts of what happened during the A&E consultation, but we could not resolve these differences because there were no witnesses.
The consultation notes taken by the nurse practitioner were inadequate and did not fully capture the symptoms she observed, the checks and examinations she carried out, or the advice she gave Mrs A.
We therefore could not say if any of Mrs A's symptoms were missed, or that there were failings in the care given by the nurse practitioner or in her decision to discharge Mrs A.
This was a failing in record keeping. However, we could not say this contributed to the distress Mrs A experienced at the time. For this reason we partly upheld the complaint.
Putting it right
Partnership of East London Co–operatives Limited created an action plan to address, with the nurse involved, the failing in record keeping we identified.
Partnership of East London Co-operatives
Greater London
Came to an unsound decision
Recommendation to learn lessons or draw up an action plan