Mrs N complained about the care provided to her mother, Mrs L, during Mrs L’s attendance at the Emergency Department of Morriston Hospital on 20 February 2024.
The investigation found that the cause of Mrs L’s hip pain was not adequately explored, and she should have had an X-ray on 20 February. If she had, it should have identified that Mrs L’s hip was fractured; as it was, this was not diagnosed until a month later, when she was referred for an X-ray by her GP. The investigation also found that Mrs L’s pain and the efficacy of her pain relief were not reassessed appropriately. She was not offered alternative or additional pain relief until 18 hours after her initial triage. In addition, there were limited references to any toileting support being offered, despite nurses and doctors noting that Mrs L’s pain was causing her to be incontinent because she was unable to get to the toilet or commode in time. Mrs N’s complaints were upheld.
The Health Board agreed to apologise to Mrs N and offer her £925, in lieu of Mrs L and in recognition of the failures identified. It also agreed to remind staff of relevant guidance on pain management and identification of fractures. It further agreed to ensure that the doctor who assessed and discharged Mrs L would share and reflect on the Ombudsman’s findings at their next annual appraisal meeting.