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Spso.w3.org.uk
SPSO decision report Case: 201102321, Glasgow and Clyde NHS Board Sector: health Subject:
communication, staff attitude, dignity, confidentiality
Outcome:
Mr C complained on behalf of his partner (Ms A) who was a hospital in-patient
receiving treatment for schizoaffective disorder (a mental disorder affecting
thinking processes and mood). Ms A was prescribed unilateral
electroconvulsive therapy (ECT – a treatment that involves sending an electric
current through the brain). This was to be provided at another hospital, as there
was renovation work taking place in the ECT unit at the first hospital. After
three sessions of ECT Ms A complained of gaps in her memory as well as a
general feeling of her mind being blank. It was found that she had received
bilateral ECT (electrical current passed through the whole brain) instead of the
prescribed unilateral ECT (electrical current passed through only one side of the
Mr C complained that Ms A was not reasonably administered her prescribed
medication in the first hospital, as she was asleep when medication rounds took
place and she was not woken. He also complained that the second hospital
provided bilateral ECT without Ms A's consent and that the information provided
before the treatment was not reasonably relevant to his partner's
We did not uphold the complaints about medication and information. We were
satisfied that the information provided prior to the treatment was appropriate.
We found that Ms A missed medication doses on around 20 occasions, mainly
of ibuprofen. However, we accepted the advice of our medical adviser that
patients would not be woken for such pain medication. Ms A also missed two
doses of depakote (a mood stabilising anti-epileptic drug). We found that this
drug should be maintained at a certain level in the blood stream and, as such,
patients should not miss their dose. However, recommended practice is for the
dose to be provided as soon as possible after the patient wakes up. If they
wake closer to the time when the next dose is due, then a dose can be missed
rather than a double-dose being provided.
There was insufficient evidence for us to determine exactly when Ms A woke up
on the occasions in question or how close this was to the planned delivery of
her next dose of medicine. We also found that such episodes were rare, and
our medical adviser said that they did not happen close enough together to
have had a significant impact on Ms A's overall wellbeing.
The board accepted and apologised unreservedly for the fact that bilateral
rather than unilateral ECT was performed. This was due to different practices in
the two hospitals. The board pointed out that Ms A signed a consent form
allowing staff to decide what type of ECT was provided. We found that the
consent form did allow bilateral ECT, but that any decision about this should be
linked to clinical need and the patient's preference. We found that unilateral
ECT is recommended in most cases and that by providing bilateral ECT the
board increased the likelihood that Ms A would experience side effects. There
was no clinical indication for bilateral ECT. The board failed to record any
reasons for deviating from the prescribed treatment, and communication
between the prescribing team and the team providing the treatment was poor.
In this respect, the board failed to comply with standards set out by the Scottish
ECT Accreditation Network (SEAN). So although Ms A's signed consent
allowed the board to carry out this treatment, we did not consider that they went
about deciding to do so in the way that the consent form suggests, and we
Recommendation
provide us with evidence of their standardised procedure for prescribing
and recording treatment within their ECT departments including specific
detail as to how specific SEAN standards (10.2 and 11.8) are being
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