Doctor’s patches care plan

A DOCTOR was asked by staff at a nursing home to urgently prescribe patches containing a powerful painkiller to relieve the pain of a dementia sufferer, an Oldham inquest heard.

Elizabeth Murfin (91) died at Treelands Nursing Home in Fitton Hill in September 2009.

On the third day of the inquest, Dr Robert Chisabingo of the Hill Top Surgery, Fitton Hill, told the coroner he was faxed an “urgent” letter the day before Mrs Murfin’s death, calling for a suggested prescription of a 25mg patch of the “strong” pain-relief drug, because she was refusing oral medication.

Dr Chisabingo told the inquest he was not comfortable prescribing such a drug without examining the patient first, whom he had only seen once before. After calling the home he told then deputy manager Jacqueline Orson he would would visit later that day.

After the examination, fentanyl patches were prescribed, with specialist measures in place.

He said: “I asked staff ‘are you familiar with the patches?’ They said they were used to them in the home and I said because it’s a very strong pain relief drug, they needed to observe the patient.”

A “one-to-one package” was put in place, which meant Mrs Murfin was to receive around-the-clock care, the court heard.

Dr Chisabingo admitted it would be a risk if she was not observed but felt comfortable with the package in place. Staff would call 999, or emergency out-of-hours services, or even remove the patch if she became unwell.

On examination the local GP admitted he was not aware of Mrs Murfin falling and vomiting days earlier and said this information would have been taken into account in his examination, if he knew.

He said he saw Mrs Murfin’s shoulder was injured and she was showing signs of agitation.

The inquest had earlier heard the cause of death as fentanyl toxicity and pneumonia, with contributing heart disease and other conditions.

Wendy Kettleton, a mental health nurse at the home, told the hearing she asked for the patch, as Mrs Murfin was spitting out medication and unable to swallow.

She said: “Mrs Murfin was in considerable pain and it was in the best interests for pain management. I had done everything I could do to make sure this lady was made comfortable.”

Proceeding