Ward treating killer bug had inadequate records, sister admits

A total of 55 patients were infected with clostridium difficile (C.diff) between December 2007 and June 2008 at Vale of Leven Hospital in Alexandria, West Dunbartonshire.

C.diff was blamed for nine of the deaths and was said to be a contributory factor in the rest.

Yesterday, the manager of the ward at the time of the C.diff cases said although some record-keeping was not up to the nursing code of practice standard, patient care was not absent.

Lesley Fox was responsible for ward six where a number of women tested positive for C.diff in 2007 and 2008.

Some of those patients later died after diagnosis.

But the ward manager told an inquiry into the outbreak that patients at the hospital were the top priority for her and her staff.

“The patient was at the forefront of everything that we did, the care of the patient was at the forefront of everything we did,” she said.

Sister Fox said there were “absences” in care plans for patients she had looked at from the time and she was aware of the situation during that period.

“Although there was an absence of nursing documentation, there was never an absence of care,” she added.

She also told the inquiry that nurses made notes about patients on pieces of paper, to brief other staff at the end of shifts, but these were later shredded.

She also said different forms for assessing the risk of falls and nutrition were available on another ward, compared to guidance in ward six.

There were also times of “extreme activity levels” and nurses were interrupted by things like telephone calls and people coming on to the ward, she told the inquiry.

Sister Fox, who also helped care for patients on the ward, said: “It delayed care but I don’t think it put my nurses’ competence in doubt. Sometimes, it would take much longer to accomplish something than would be acceptable.”

She said the delays were not “for hours” and cases were prioritised on the ward.

Sister Fox also said nurses were at the bedside of patients the “majority of the time” and there was “constant assessment” of those in their care.

She was giving evidence to the inquiry which resumed yesterday at Community Central Halls in Maryhill, Glasgow.

Sister Fox said she gave advice on the records but the paperwork could have been “better”, although she insisted care of the patient took “precedence”.

She said: “We did discuss it and it would improve. The improvement, unfortunately, was never maintained.”

Sister Fox said assessment of patients when they were admitted covered mobility, diets and whether there had been changes in the amount of food eaten.

The nurse also told the inquiry that she believed what she was documenting “satisfied the needs of the patient”.

But she agreed with a suggestion by Colin MacAulay QC, senior counsel to the inquiry, that nurses being busy may have been a reason for the poor record-keeping.

Speaking on behalf of the C.diff Justice Group, Michelle Stewart said: “To hear evidence from the nurses is upsetting and going to bring back a lot of painful memories for all of us affected by the outbreak.

“We remain convinced that the reasons behind the suffering at the Vale of Leven don’t just lie with the individual nurses involved – they are one part of a bigger picture.

“We want to know how this happened to our families and to make sure that no-one ever has to go through what we have.”

The inquiry continues.