A FAILURE to record a morphine dosage for a hospital patient who later died of a suspected heart attack has been criticised by a health watchdog.

The Scottish Public Services Ombudsman (SPSO) upheld a complaint against NHS Fife submitted by a person, described as C, about the care and treatment their late parent, described as A, received from the health board.

Patient A was admitted to A&E at Victoria Hospital following a fall at home and found to have fractured their femur and was subsequently transferred to a ward.

A died shortly after transferring to the ward. No post-mortem was required by the Procurator Fiscal and a heart attack was recorded as the likely cause of death.

The SPSO report said C said that they were told by the board's staff that tests carried out in the A&E did not indicate any problems with A's heart so no additional monitoring was required when A transferred to the ward.

"C complained that the board's staff failed to note and act upon a number of “red flag” symptoms that should have highlighted that A was at increased risk of a heart attack," said the Ombudsman.

"C noted that A had been given a high dose of morphine by the ambulance crew. C complained that the board's staff failed to adequately monitor A's general condition or their reaction to the morphine."

The SPSO found that A's general condition was reasonably assessed in the A&E – a heart scan had been carried out and no concerns were raised

The report continued: "Whilst A displayed a number of symptoms that could have been linked to a heart problem, the tests carried out by hospital staff were thorough and gave no indication that there was a need for any specific additional heart monitoring when A transferred to the ward.

"A was given a high dosage of morphine by the ambulance crew. We accepted medical advice that the hospital staff should have been aware of this and that they should have monitored A's response to this medication.

"We found no record of the morphine dosage having been recorded upon A's admission to hospital, or of specific monitoring taking place to check for any adverse reactions to the medication.

"A displayed symptoms that could have been caused by morphine. It was not possible to determine whether A's death was caused by a problem with their heart, or a reaction to the morphine. However, we were critical of the board's failure to record the morphine dosage and monitor A's reaction to it throughout their admission."

NHS Fife were told to apologise to C and their family for the failures identified.

It told the health board to confirm whether they assess patient care against the Scottish Standards for the Care of Hip Fracture patients and provide details of any learning and improvements resulting from C's complaint.

NHS Fife's Director of Nursing, Janette Owens said: “We accept the Ombudsman’s findings in this case and note their observations that the cardiological testing that took place was thorough and appropriate, and indicated no concerns about the patient’s heart.

“We have apologised to the family for the issues identified around the recording of the pain relief administered by ambulance personnel on the way to hospital, and indeed the clinical observations necessary following the administering of this medication. The recommendations of the Ombudsman have also been implemented in full.”