WEXHAM PARK HOSPITAL, SLOUGH: A PATIENT’S VIEW.
THIS blog details my 13-days at Wexham Park Hospital in Slough for a recovery period following robotic surgery to have my prostate removed because of cancer.
It details incidents, accidents, staff, facilities and equipment in the hope that future patients can read it and learn about Wexham and that Wexham can read it and use my observations to improve care quality. The blog will also be made available to the Care Quality Commission.
I arrived at Wexham on the morning of Tuesday, January 7th at about 7.20am having travelled up about 140 miles from Weymouth, Dorset, two days before to start medication preparation for the operation.
Initial impressions were that Wexham was vast, a huge complex, and it swiftly emerged that more needs to be done to help orientate patients and visitors because no paperwork sent me ahead of my operation showed me how to get to where I was supposed to be going.
This difficulty and stress levels were made worse by not being a local resident, so on arrival at main reception I had no site map, no directions and no destination name to guide me to my operation point.
Solving this problem should have been simple, but I knew I had to check in by 7.30am as ordered, so time was tight only for me to find out that main reception didn’t open until 7.30am.
In fact, by nearly 7.40am there was still no-one there, more stress I didn’t need on an already stressful day so myself, my wife and our friend desperately launched out in to a hospital just coming awake to try and find out where I had to go.
Over the next 30-40 minutes we received something like six different and often conflicting sets of directions – all from hospital staff – all of whom were friendly but all of whom seemed mystified by the presence somewhere at Wexham of a surgical unit which did radical prostatectomies.
We finally realised that a series of little coloured symbols related to various medical functions – no-one had told me in any form of prior correspondence that this was how to navigate Wexham – and we finally tracked down where I was supposed to go, arriving pretty stressed not at 7.30am but just before 8.10am.
Staff welcomed me and I was asked to get ready including a toilet visit if I wanted.
The first toilet I tried seemed fine but, on pushing the door wide open, I was shocked to see a large pile of blood-covered faeces on the floor. A bit rattled, I reported what I had found before getting ready as best I could. I was then taken to a small room outside the operating theatre where I received anaesthetic.
I woke up later in Bed 28 of Ward 2 where to my delight I was told by my wonderful surgeon Mr Omar Karim, that the operation had gone very well indeed.
Mr Karim deserves nothing but the highest praise. He may be recognised as the top robotics surgeon in the country but there is far more to him than that because he is also friendly, knowledgeable and informative on top of that, all qualities a patient values. He even personally visited my bedside five times during the next 13 days to monitor my progress. Very reassuring.
What followed next on the night of January 7th in to January 8th was the worst night I have spent in any hospital anywhere in the country.
It underlined the true state of Wexham – and perhaps the NHS on a wider scale – with clear evidence of chronic understaffing with all the diificulties and dangers that involves.
Not a wink of sleep did we get all night during which:
- Three men screamed out in agony at the top of their voices at different times of the night
- An estimated 300+ buzzers, bells, bleeps, alarms or klaxons went off
- Patients were constantly startled by night staff’s use of ring folders which were opened with a “crack” and closed with a loud “snap”
- Constant comings and going, lights turned on, then off, then on again, sometimes for the whole ward but also for individual beds as staff worked on patients.
I’m sure all this may just have been a bad night but it was unfortunate that it was my first night recovering from a major operation, so it was difficult to just lie there. Sleep was impossible.
I was shown the bed up and down button but not where it was being stored and I was not told about the call button at all
January 8th was a growing nightmare with slowly increasing pain and I just couldn’t face doing anything.
On January 9th the drip in my left arm was removed but my wound drain stayed in while my catheter started to bypass and I started to experience acute stomach bloating.
At this point I will flag up heavy praise for Staff Nurse Ashling Clancy – who later left to join a new hospital – and her colleague, Sarah Ababio-Kissi.
It was Sarah who, after I had endured 27 hours of absolute agony with my stomach – now nearly three times its normal size – said she was concerned that something wasn’t quite right.
She decided to change my catheter bag from a solid plastic bed box type to a flexible leg bag type. It was then she noticed that the catheter pipe clamp had been put on too tightly.
In the time it took her to fit the new bag, turn away and put the old bag to one side and turn back towards me the new bag had filled.
By the time she had finished, Sarah had drained 800ml of urine and blood from my stomach where it had backed up because the clamp had been put on too tightly.
Instantly I began to feel a bit better, but it was still 27 hours of pain because of someone’s mistake which brings me to the serious concerns I have over the documentation system at Wexham.
There was no doubt in my mind that the clamp had caused the major stomach problem I developed, no doubt in Sarah’s mind, no doubt in the mind of the urology staff and consultant who saw me and no doubt in the minds of my visitors that I showed dramatic signs of improvement once my stomach had been drained.
But Wexham at this time was already the subject of a damning CQC report on its failings and a warning that it could be fined if it didn’t improve, so somehow the incident of the clamp – which everyone knew had caused my condition to deteriorate sharply – only appeared on my Hospital Leaving Letter under “Inpatient Management” as “patient developed abdominal distension post-op”, implying that my condition had somehow been a reaction to the operation.
This is a lie. My agonizing stomach swelling was due entirely to the catheter pipe clamp being put on too tightly which backed 800ml of urine and blood into my stomach. Wexham may want to gloss over what happened but I don ‘t.
I also have other serious concerns with Wexham’s documentation system – notably over one incident where patients in the beds opposite me were given each other’s drugs by mistake – but I will deal with that when I get to it.
Having had my stomach drained, the real recovery began. I was given lots of lovely enemas to help me open my bowels after that setback and I had a much more restful night on January 10th. It was still no picnic but I was able to draw bed curtains and just lie there until John, a seriously ill pensioner who was losing a lot of blood, was brought back at 1am. I had to make loo visits at 2am and 6am but in between it was very peaceful just lying there.
Several milestones on January 11th with my first bowel movement and the delights of two Weetabix for breakfast. There was also a nice touch when one staff member brought their children on to the ward who passed round a box of chocolates for patients. Much appreciated.
But the day was marred by a terrible incident just when we all thought the day was over.
The lights were lower at 10.20pm when an 82-year-old man in the bed opposite me was given the drugs of a 30-year-old man in the bed next to him after their case notes were wrongly left on each other’s beds.
Shockingly the 82-year-old had already taken two of the wrong medicines – powerful morphine-based pain killers – before the rest of us began to smell a rat.
It was pure luck that we were able to something because the 30-year-old was normally asleep by now but had had a bad afternoon and was now sat cross-legged on his bed doing a crossword.
The drug trolley nurse – we understand she was an agency nurse brought in because Wexham was so short staffed – asked the 30-year-old to take his first medicine to which he commented that he wasn’t usually given this item. When she offered him a second item he not only said he didn’t usually take it but questioned whether she had the right case notes.
The nurse replied that the items were all written down in the notes, the nurse then offering the 30-year-old double his usual level of morphine which was dangerous.
It emerged she had the wrong notes belonging to the 82-year-old and we asked her to report the incident immediately in case his life was in danger.
She replied that she would report what had happened but only once she had completed the drug round.
Quite clearly the 82-year-old might have become seriously ill or died by the time the round was over, so the 30-year-old and I forced the issue, got it reported to senior staff and a major inquiry was launched.
We were told that senior representatives would come round to see us later but that didn’t happen until 12.25am. Cynical us wondered if the delay was so we’d fall asleep waiting which would allow the bureaucrats to say they hadn’t wanted to wake us up! Eventually the hospital’s only Junior Doctor and its Senior Surgical Wards Manager did visit to apologise to us all for what had happened.
We heard two days later through the excellent ward manager Sally Cooper that steps were being taken to both identify what had happened and what needed to be done to prevent it happening again. I should add that the agency nurse in question failed on both occasions to ask the name of the patient she was administering to or their date of birth. Other nurses before and since did this. She did not. A simple check but it works.
The aftermath of the incident meant the 82-year-old wasn’t able to go home the next day as planned. His bowel movements had been fine, but being given the wrong drug bunged him up, his bowel motion stopped and staff rescinded his leaving and put it back a day when he was able to leave.
January 12th was my first natural bowel movement for five day. Toilet facilities both help and hinder with this. One toilet has a lot more space and was therefore ideal for patients like myself with restricted movement. The other toilet was much tighter for space and more suited to those who could manoeuvre themselves about a bit. The larger toilet often needed cleaning, but staff were good about this and did so pretty much the moment the need for cleaning was pointed out. With such heavy use of the two toilets, this situation was not surprising.
This was also the day we read about Wexham Park being criticised by the CQC. There was also a damning national newspaper report on the appalling situation at Wexham which allegedly included arguments and fights among some surgical staff, sometimes actually in the operating theater with a patient lying there unconscious.
The CQC report is interesting because it claimed to have found “short-staffed wards” (Very true. They were cripplingly short of staff while I was there); “evidence of poor record keeping” ( I totally agree with this. Just on my little ward there were numerous incidents of patients’ records being written up in an ambiguous fashion. This meant morning staff might do or say one thing but, by the time night staff came, the notes often didn’t make it clear whether the drugs in question had been discontinued or whether the mention was for them to continue).
As a patient, this meant I was often told one item was being stopped only for me to be offered it again by the evening drug round. Very confusing and more than a little worrying.
On January 13th I was offered as part of my meal a cup of vegetable soup which was the worst hospital food I have ever had anywhere. It wasn’t even acceptable to grout tiles with. This must be a source of some concern for the hospital and for the CQC because appetising food has to be a key element of all patients’ recovery. On a scale of 10, the best I could offer Wexham was a 3 or 4 and that’s being generous.
On January 14th there was another serious mistake made by staff which unfortunately again involved myself.
I had been scheduled for a sigmoid check and was therefore given an enema at 8pm and another at 10pm to clear my bowel overnight ready for the procedure the next day. This would allow the camera to check that my bowel was not damaged and was not linked to the problems I had been experiencing.
So I went through 17 hours of no liquid by mouth, 24 hours of no food and a sleepless night spent shunting back and forth between bed and toilet only to be wheeled down to theatre the next day to be told by staff there that they couldn’t deal with me because I had been given the wrong preparation procedure!!
I then had to go back on ward, have a quick meal and then begin the starving and nil-by-mouth process all over again, this time being given the right preparation treatment. I was very unimpressed by that.
On January 16th I had my sigmoid tests and the results were fortunately very good and I was taken back to my ward to enjoy lunch, only the second out of the previous eight meals I had been able to have.
More delays then followed with a different scan. This one had been ordered by my consultant so he could see how my stomach wounds were healing. I was told I wasn’t on the scan list that day. The next day my consultant, Mr Karim, specifically discussed my scan at a big morning meeting during which it was upgraded to a “priority scan”. This was also ignored.
Only on the third day of asking at about 4pm did I get the scan. Throughout the whole of this period I was just left to stew. No one told me why there was a delay or when I might be dealt with.
The scan did reveal that the healing for one perhaps two of my wounds had been affected by the earlier clamp error and I was told I would have to wear my catheter for an extra eight days because of this. Just the thought of that was awful and the reality of eight days of extra catheter use is very nasty indeed with all its inherent problems.
Finally on January 19th the big day came when I was discharged and could be driven the 140 miles home. It was not until I got there and looked at my discharge letter than I realised the mistake with the catheter clamp had been whitewashed over as “Patient developed abdominal distension post-op”.
This is, of course, an accurate statement but it completely hides the reason why I developed such a grossly distended stomach and instead makes it appear like it was a physical reaction by me to the operation rather than a mistake which made me seriously ill. I can only presume this was done to avoid drawing CQC attention to the incident. Fortunately ward manager Sally Cooper is on the case and she is very good.
So in all, watch your step as a patient at Wexham. I cannot speak too highly of the nurses there whose devotion shines through 15-hour shifts. They genuinely care about patients and wer crucial in helping me get through my stay at Wexham, but I wouldn’t give you tuppence for the bureaucrats, the paperwork system and organization or the way staffing levels are approached.
Over to you CQC.