Medication Details - Factual

Pain Management for the End of Life Care given to Thomas Milner, Case No.6 Patients Association Report, FLUCTUATED from being given 5mgs. morphine per hour 7/1/06 to ending up 1 hour prior to death 11/1/06 on 10mgs. morphine per 24 hours!

Medication Details as taken from the Medical Notes:

He began to receive 5mgs.morphine subcutaneously 7/1/06 after being resuscitated at the NHS Sheffield Northern General Hospital A.& E. Department. Although in the Medical Notes it said DNR - reason = futility! (Thomas was suffering from terminal myeloid leukaemia which had been diagnosed 6 months earlier).

We were told that he had signs of dying and that he would be able to feel his systems closing down and that 5mgs. morphine per hour was the 'most humane thing to do'.

Transferral to another ward and team meant another regime/end of life care plan!

For obvious reasons 5mgs. morphine per hour was not written into the medical notes. (This amount of morphine and build up of morphine would really have meant that Thomas would have been unconscious and then he would have drifted off into death). So this new team on this new ward were not aware that Thomas had been receiving 5mgs. morphine per hour.

However Thomas continued to receive morphine injections 2.5mgs every couple of hours in the early hours of 8/1/06 and for the rest of that day whilst now on the MAU ward at the NHS Sheffield Northern General Hospital.

At 2.00a.m. 9/1/06 on the MAU ward of the NHS Sheffield Northern General Hospital, a syringe driver holding 10mgs. morphine and midazolam was set up with prescribed extra (prn) morphine as required.

From this time until he was taken out of his death bed on the MAU ward and wheeled outside in the cold to be admitted to the NHS Northern General's Palliative Care ward, Sheffield 18.00p.m. 9/1/06, the syringe driver was holding 10mgs. morphine. Thomas had needed several extra - additional injections of morphine from set up 2.00a.m. 9/1/06 until now 18.00p.m.9/1/06 which was a 14 HOUR period. (It was recorded at 18.00p.m. 'Tom too ill to have discussion with staff'.)

Medication Details from 18.00p.m. 9/1/06 until 8.10a.m 10/1/06 now on the NHS Sheffield Northern General Palliative Care ward show that he had NEEDED 6 x 5mgs (30mgs) of extra morphine and midazolam medication drugs. That was another 14 HOUR period.

The NHS Palliative Care Consultant did a ward round at 10.30a.m.10/1/06. The syringe driver had now been in place for 32 HOURS holding JUST 10mgs. morphine.

She failed to CALCULATE AND CONSIDER any additional morphine (prn) medication that had been required in the previous 24 hours and left the syringe driver holding JUST 10mgs. of morphine. This is NOT Standard Palliative Care practice. (The Healthcare Commission found that this level was 'LOW IN THE CIRCUMSTANCES. Does this NHS Palliative Care Consultant need more training?) (Medical Notes state 11.30a.m. 10/1/06 'Tom probably unaware of his surroundings').

Added to this, the day nursing staff on the NHS Palliative Care ward REFUSED to give Thomas his extra morphine. (They also did NOT see to he toiletry needs and left him lying in his own urine and blood).

Thankfully on the return of the previous evenings night nurse, she resumed the extra morphine as prescribed. This nurse also changed Thomas and his bed sheets and tried to make him as comfortable as possible.

6.15a.m. 11/1/06 This nurse entered into the medical notes: 'Tom in pain, restless, agitated NEEDED at lot of prn drugs (extra morphine)'.

7.30a.m. A new team of nurses had arrived but said when we went to the nurses station that they could NOT give him anything and that we would have to wait until the Doctor's did their rounds. They could not give us a time for this.

In desperation I phoned the family G.P. at 8.30a.m.

A Junior NHS Doctor appeared and at 9.30a.m. the syringe driver was changed to 20mgs. morphine. This DOUBLING OF MORPHINE is NOT Standard Palliative Care practice.
This Junior NHS Doctor wrote in the medical records: 'CALL FROM G.P. - TOM PULLING AT THE SHEETS'.

I held my Dad as he died. That was 1 hour later at 10.30a.m. 11/1/06

Pain and Medication Management in Palliative/End of Life Care Training is said to need a new 'initiative' - but why can't we just have common sense, compassion and basic care?

Suffering has no boudaries, neither should compassion.

GOD HELP US ALL AND SHAME ON THEM!

The Medication Details listed here are taken from the Medical Notes.

Explained here is Pain Control in Terminal Care