Call for guidelines on use of strong painkillers at home

It comes after Jan Doidge, 65, was allowed to administer the opioid opiod painkiller Oxycodone to her husband Mike, without their GP practice putting in relevant safeguards or seeking advice from specialists.

The Scottish Public Services Ombudsman (SPSO) yesterday raised concerns after discovering the shortcomings at the practice in NHS Grampian about the best way to give a new drug to a terminally ill lung cancer patient.

Now, the ombudsman will write to the governing body the General Medical Council (GMC) to highlight the concerns and investigate implementing nationwide rules on home prescribing.

Mrs Doidge made a formal complaint to the ombudsman regarding the treatment of her 69-year-old husband.

A doctor allowed her to administer the drug at home to ease his chronic pain.

But a fellow health professional raised concerns about her being allowed to inject Oxycodone and wanted her to seek permission, in a move that could see her husband suffer for hours in pain before she talked to a doctor.

Following an investigation, the SPSO has found the GP’s practice had failed to ensure Mr Doidge’s consent to the “informal arrangement”.

Following yesterday’s ruling, Mrs Doidge said: “I hope this will lead to better understanding of the best way to inject these sort of drugs and avoid the excruciating pain that delays can cause.”

“It was confusing and Mike was suffering enough at the time, but we had to wait sometimes for up to four hours to get a doctor or nurse to inject the drug.

“I wanted to pay for a night nurse to do it at night, but then the GP said I was fit and proper to do it and Mike had the faculties to approve it.

“But then I was told to get permission from a nurse before I could do it. It made a bad situation worse and I look forward to seeing what the General Medical Council decide.”

Mr Doidge was diagnosed with lung cancer at Aberdeen Royal Infirmary in January 2015 and subsequently was discharged in February into the care of his medical practice.

He received regular visits from both district nurses and GPs during his time at home.

But On March 17, one of the GPs told Mrs Doidge she could give her gravely ill husband “breakthrough medication” – in the form of opioid painkillers.

However concerns were raised just a few days later about her using the medication without first seeking medical guidance, as she had been told to do.

Mr Doidge died at home less than a week later.

Mrs Doidge later made a number of complaints against the practice.

The SPSO said it was “extremely concerned” about what was effectively an “informal arrangement” between the practice and Mrs Doidge which allowed her to “administer a controlled drug without the practice first putting adequate safeguards in place or seeking guidance from a specialist.”

“Furthermore, I agree with the Medical Adviser that it is of concern that GPs continued to prescribe a controlled drug after expressing concerns that Mrs C had administered the medication without clinical advice.

“I am also critical that the practice failed to ensure that their patient, Mr A, consented to this arrangement and of their poor response to my complaints reviewer’s enquiry about this. I uphold the complaint.

“I intend to write to the GMC to draw their attention to my concerns about the risks to patient safety arising from the lack of governance arrangements and documented patient consent in this case.”

The SPSO made a number of recommendations following its investigation, including ensuring that the GP’s who instructed Mrs Doidge in relation to administering pain medication seek support from NHS Grampian’s clinical support group.

This is in relation to responsibilities for prescribing and consent under GMC guidance.

GPs are also to discuss the findings of the investigation at their annual appraisal as well as familiarising themselves with GMC guidance as a priority.

NHS Grampian said the practice has acknowledged the recommendations and that they were being implemented in full.