The old man was unable to swallow anything after spending two days in A&E without being given the correct medication, and died four weeks later.
In the “terrible” case that raised new concerns in the state of urgency NHS care, the 85-year-old was sent to the emergency department of the hospital after the installation. Among the huge delays, her A&E wait went on for a third day, with most of it spent in bed in the corridor.
He had Parkinson’s disease and sought medication at various intervals to control his symptoms. During his time in A&E, the man should have received 18 cups, but seven were not given and three were given late, according to a report by Health Office of Health Security Investigations (HSSIB).
The report, which does not name the patient or the hospital, highlights how a man was advised to go to A&E after complaining of pain following an accident at home the day before.
After 52 hours in A&E, he was finally admitted to care where his Parkinson’s symptoms worsened and he lost the ability to swallow, HSSIB said.
He died four weeks later, with the cause of death listed on the death certificate as a severe chest infection, Parkinson’s and the frailty of old age.
The HSSIB report highlights how people are spending more time in an A&E bed than in the corridor due to requiring services. The care corridor can cause problems for emergency staff because it “spends opportunities to store medications from the home,” the authors said.
They pointed out how there was no immediate response to the staff being set up to receive the time-critical medication. And the prescribing staff could not check appointments with the GP practice or the specialist Parkinson’s team working out of hours.
A&E staff also received conflicting information about medication dosage from the patient’s and her child’s records. GP staff accepted the information “as a very accurate record, but the information it contained was incorrect”.
The researchers found there were “no defined roles or responsibilities in the general requirements so that patients who needed time-critical drugs were identified, and drugs were prescribed as soon as possible.”
The HSSIB warned that “patients in need of medicines may suffer harm if these are not provided”, while it called on health bodies to adhere to specific guidelines for experts in drug-sensitive patients.
The latest performance data for the NHS in England shows 49,592 people wait more than 12 hours in A&E in October by the departments in the matter of admitting in fact, the third figure of the last month with comparable records began in 2010.
Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said the case was shocking and tragic.
“[This] as a call to action for all emergency department clinicians. No patient who enters the emergency department should fear that their safety will be jeopardized because they cannot access a regular prescription when needed,” he said.
“Ask patients if they are taking a time-critical medication, and when the next dose is due, is one of the questions every clinician asks.
“This simple inquiry is increasingly relevant to reducing the longest A&E time more and more people are suffering. In this tragic case – an appalling 52 hours.”
Deinniol Owens, deputy director of research at HSSIB, said: “When patients are in the emergency department, it is crucial that, in addition to any emergency treatment needed, medication is required for other priority conditions.
“The case that was examined in this research was a sobering example – if patients do not receive their Parkinson’s medicine, it can make them seriously ill, and over time it increases the risk of damage and reduces the effectiveness of the medicine.
“It affects patients and their families, and in this case the family was not always heard, even though they shared his needs and emphasized how important the right dose was.
“Our research makes a number of important findings in relation to critical medications that are considered at the moment in emergency departments.
“We’re sharing this at the national level with ready providers to see how they administer critical medications, in a busy and difficult environment, and how to get patients on the road in a timely and safe manner.”