Stroke Medical Negligence Patient Safety Inadequate Patient Discharge Instructions

Stroke Medical Negligence Patient Safety Inadequate Patient Discharge Instructions

John Whelan Solicitor with specialist expertise in Stroke Medical Negligence gives a case example of Inadequate Patient Discharge Instructions.

An example of a case where inadequate Patient discharge instructions led to complications and worsened the Patient's outcome:

Case Example

A Patient with a history of hypertension, type 2 diabetes, and hyperlipidemia, was hospitalised after suffering a non disabling ischemic stroke.    The Patient was treated with aspirin and statins, and the Patient’s condition stabilised during his hospital stay.   The Patient’s discharge was planned after three days, and the Patient was cleared for home with instructions to follow up with GP and a neurologist.

Discharge Process:

a)       During the Patient’s hospital stay, the Patient’s condition improved, and he was able to regain full motor function. However, due to the lack of detailed communication and incomplete discharge instructions, several key aspects of his post discharge care were overlooked.

b)       The Patient was discharged with a prescription for blood pressure medication and antiplatelet therapy but was given minimal guidance on how to manage medications, what signs and symptoms to watch for, and how to monitor the Patient’s blood pressure at home. The Patient was also not informed about the importance of lifestyle changes to reduce stroke risk.

Inadequate Discharge Instructions:

1. Unclear Medication Management:

a)       The Patient was given a prescription for medication for blood pressure and aspirin for secondary stroke prevention. However, the Patient was not clearly instructed on when and how to take these medications, or about possible side effects such as dizziness, fatigue, or gastrointestinal discomfort.

b)      No discussion was held regarding the importance of regular blood pressure monitoring or target blood pressure ranges to aim for.

c)       The instructions lacked specifics on how to adjust medication in the event of side effects or if missed doses.

1. Failure to Provide Guidance on Stroke Warning Signs:

a)       The Patient was not adequately informed about the signs and symptoms of a recurrent stroke (e.g., weakness, difficulty speaking, severe headache). There was no clear emphasis on when to seek emergency care if these symptoms reoccurred.

b)      Additionally, the Patient was not told about the importance of early intervention in case of another stroke, which could have made a significant difference in reducing further brain damage.

1. No Follow Up Plan:

a)       The Patient was instructed to follow up with the Patient’s GP and a neurologist but was not given specific details about when to schedule the appointments or what to do if the Patient encountered difficulty in scheduling them. The instructions were vague and lacked clear timeframes, leaving the Patient uncertain about the urgency of follow up care.

b)      No written follow up appointment scheduled or contact information for the hospital was provided, which could have facilitated the Patient’s ability to seek help if needed.

1. Lifestyle Changes Not Emphasised:

a)       The Patient was not provided with detailed instructions regarding dietary changes, physical activity, and other lifestyle modifications necessary for stroke prevention (e.g., weight loss, managing blood sugar levels, reducing sodium intake, quitting smoking).

b)      Although a dietician had met with the Patient briefly during his hospitalisation, there was no follow up plan or resources provided for the Patient to continue making the changes after discharge.

Outcome of Inadequate Discharge Instructions:

a)       After discharge, the Patient struggled with managing blood pressure due to lack of clear guidance on how to monitor it at home.  The Patient missed several doses of medication due to confusion about the dosing schedule and experienced side effects (e.g., dizziness) that were not explained to the Patient.

b)       Two weeks later, the Patient began to experience severe weakness on one side of the body and slurred speech.   The Patient mistakenly attributed these symptoms to medication side effects and did not seek immediate medical help. By the time the Patient called the GP it was too late to prevent the damage caused by another stroke.

c)       The Patient was diagnosed with a recurrent ischemic stroke and required a longer hospital stay, during which the Patient had a complicated recovery that included speech therapy and rehabilitation for motor deficits.

d)       Furthermore, the Patient did not make the necessary lifestyle changes after discharge. The  poor blood sugar control and lack of exercise worsened the Patient’s health and recovery, contributing to stroke risk.

Important Points of the Case:

1. Unclear Medication Instructions.

2. Failure to Educate on Stroke Warning Signs.

3. Inadequate Follow Up Instructions.

4. Lack of Focus on Lifestyle Modifications.

For more detailed insights into how Stroke Medical Negligence and Patient Safety impacts you and how Whelan Law can support you, please visit our Patient Safety Rights Legal Advice https://www.whelanlaw.ie/news/stroke-medical-negligence-claims-what-you-need-to-know/