The 52-year-old patient had been to see her GP complaining of feeling generally unwell, having episodes of feeling cold and shivering and feeling sick. She had a history of urinary tract infections and felt it was likely she had another one.
The patient had complained of pain in her suprapubic area, so the GP examined her abdomen and carried out a dipstick test on her urine, the result of which suggested an infection. The GP prescribed broad spectrum antibiotics pending the result of the urine microscopy and culture, and advised plenty of fluids and paracetamol.
The patient's partner rang the practice later that day to say that she had vomited and felt hot but was shivering. On listening to this call during the complaint investigation, it was obvious that he was very concerned about her. The duty doctor advised giving the antibiotics chance to take effect and to continue the symptomatic treatment. No safety netting advice was given following the first consultation or by the duty doctor.
The partner explained that the patient had deteriorated further during that night and had collapsed at home and an ambulance had been called. Her temperature had been recorded at 38.5oC, she was tachycardic and her blood pressure was low.
Once in the emergency department, she was diagnosed with sepsis and started on intravenous fluids and antibiotics. Her partner was angry that the GP had not fully assessed the patient, and that the duty doctor had not taken his concerns seriously when he said the patient had deteriorated and he felt she was very unwell.
Complaint response
The MDU adviser helped the GP respond to the complaint. As part of the investigation, the practice had a clinical meeting to discuss the care provided by both doctors. It was acknowledged that the initial consultation lacked a full assessment of the patient and that her observations, including temperature and blood pressure should have been checked.
Her partner was angry that the GP had not fully assessed the patient, and that the duty doctor had not taken his concerns seriously when he said the patient had deteriorated and he felt she was very unwell.
Safety netting advice should also have been given, explaining to the patient what signs and symptoms to look out for in case of severe infection. The importance of considering relatives' and carers' concerns was also highlighted and that the deterioration in the patient's symptoms should have been taken more seriously. At the end of the second consultation, if a decision was made not to see the patient again, safety netting advice should have been given again.
As part of their learning, the clinical staff updated their knowledge on local and national guidance on sepsis. A leaflet was produced to give to patients, explaining what to look out for in case of deterioration and when to seek urgent help. As well as informing the patient, this was intended to help carers identify when to get further advice.
Once the patient was well enough to give her consent for information to be disclosed, the practice responded to her partner. The partner was satisfied that the doctors involved had reflected on their involvement in the patient's care and had learnt lessons from this that would be implemented by the practice going forward. As a result, the complaint was closed.