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"My experience of re-presenting to ED"

About: Karratha Health Campus / Emergency Department Karratha Health Campus / Surgical Services

(as the patient),

First of all, I'd like to explain that I am a Clinical Nurse from interstate working on a temporary contract. I am alone in The Pilbara with no family, living alone. I have over 30 years nursing experience and 16 of those years as a Wound Care Specialist Nurse. I am fit and healthy and have a past medical history of breast cancer that required mastectomy, chemotherapy, radiation a few years ago and I continue to be on hormonal treatment. I had a breast reconstruction and have bilateral implants.

A few weeks ago, I noticed a small pin head sized pink dot on my abdomen which was unusually painful for its size. I kept a close eye on it throughout the next two days, I booked in to see a GP at my place of work who diagnosed it as a normal reaction to an insect bite. We swabbed the area despite the opening being extremely small. Swab was sent to Pathwest. I became increasingly lethargic and took the next two days off work.

The area increased in size but pain but was manageable. I kept a log of photos.

On a weekend recently, I woke up to the area being extremely cellulitic. The pain increased and the skin was breaking down. I sent a photo to my best friend interstate who is a Consultant Plastic Surgeon, they advised me to go immediately to ED. I had not experienced a fever. The cellulitis was increasing, tracking towards my implants which concerned me. At this stage the pain was so great that I had difficulty getting into the car or walking, the infection seemed to be worsening rapidly.

I drove myself to the hospital. I presented to ED Triage where a nurse took my history and put an id band on my wrist. The doctor came and called out a name. Not being my name I ignored them. As I was the only female in the waiting area the doctor questioned my name and it was established that the incorrect patient details were on the wrist band that had been put on my wrist. The wristband was changed by the nurse and I was taken into the ED area. The doctor examined me and quickly established that I needed admitting for Iv antibiotics. I was commenced on IV clindamycin. I informed them that a swab was taken a few days prior at my work but I was unaware of the result. I would like to add here that the doctor and their team that night were exceptional and could not be faulted at all.

I was transferred to the ward, overnight I was given adequate analgesia and further doses of IV clindamycin.

At around lunchtime the next day (unsure of time) a doctor came and said I could discharge home on oral Clindamycin as my blood levels were not exceptionally out of range and no temperature. I was given a prescription and told to collect from pharmacy in town, I was discharged alone and drove myself to the pharmacy in Karratha. I vomited in the car on the way and felt quite unwell. As I have no family in Karratha I had no one to come to pick me up. I drove home to my single cabin at a FIFO camp.

I continued to vomit all afternoon and fainted whilst on my own. I put myself to bed but the pain by now was 10/10. At around midnight I drove myself back to Karratha Health Campus and represented at triage. I advised them I had been discharged earlier that day. I was taken into a room behind triage to have observations done then, sat on a single chair in the fast track area for over 1.5 hr. I know this as there is a clock above the door! There were no other patients in this area, I was not spoken to nor checked on by anyone, no observations were done and no analgesia was offered/given despite the triage nurse seeing and knowing my pain score.

A doctor finally came and asked me to follow them into a room. I struggled to stand, bend over to pick up my backpack and dragged my bag into the room. This doctor did not assist me with any of this. This upset me. After their assessment, I became tearful, I felt as if they didn't believe me about my pain and stated that if they don't want to help me I will leave and fly home interstate the next day. They then took me to an area where I could finally lie on a barouche. It was at this stage I informed them I was a Wound Care Specialist Nurse and that I was requesting to see a surgeon. They stated a surgeon would see me in the morning as there was not one available during the night.

At the early hours of the morning, I messaged my partner who is interstate to inform them of the events. (They are also a senior Registered Nurse). They were upset as to how I had been managed.

I waited until the morning for Dr Anthony to visit. My work manager was present during the consultation. Surgeon agreed that I needed to attend theatre for excision and drainage.

To end may I please add that my theatre experience was a positive one. The anesthetist and the nursing staff along with Dr Anthony were understanding and caring. I was discharged 45 mins post-op into the care of my work manager who cared for me overnight. No post-op discharge summary was provided.

I was reviewed by Dr Seema who established that my swab preop grew MRSA. Clindamycin were changed to Bactrim.

Responses

Response from Lisa Smith, Operations Manager, West & Inland Pilbara, WA Country Health Service (WACHS) Pilbara last week
Lisa Smith
Operations Manager, West & Inland Pilbara,
WA Country Health Service (WACHS) Pilbara
Submitted on 10/06/2021 at 18:23
Published on Care Opinion on 11/06/2021 at 15:31


Dear Interstate Nurse,

Thank you for your valuable feedback on your recent presentation and re-presentation to Karratha Health Campus.

I am sorry that there were significant aspects of your care that left you in large amounts of pain and having to manage this whilst feeling extremely unwell on your own.

I would also like to apologise for the lack of attention provided to you by the doctor who left you to manage your own bag whilst in a state of significant pain. This is not the level of care and attention we require from our medical staff.

I will be following up with our Senior Medical Officer and District Director of Nursing regarding:

What the current turn-around time is for lab results and the process for informing patients of results such as yours.

* A review of the process for providing wrist bands to patients and how someone might be given the wrong band.

* The process for reviewing and monitoring patients in the room behind triage and why someone might be left for 1.5 hours without monitoring.

* A review of the process for discharge from the ward and ensuring our patients have appropriate transport from hospital, ability to fill prescriptions at an external pharmacy, and support at home.

* Why a post-op discharge summary is not provided in situations such as yours.

I would like to thank you, that despite your overall poor experience, you were able to share generous reflections on the positive experience you had in theatre, and that you felt cared for and understood.

If you would like to discuss your experience any further or receive feedback on our investigations as outlined above, I invite you to contact me. My name is Lisa Smith and I am the Operations Manager West & Inland Pilbara. You can contact me on 08 9144 7639, or my email is Lisa.Smith3@health.wa.gov.au

Kind regards,

Lisa Smith

Operations Manager West & Inland Pilbara

WA Country Health Service (WACHS) Pilbara

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