Unusual bruising

Question 1

A nurse tells you a family member of a patient has found some bruising on a patient. The nurse has had a look and thinks it does look like bruising. The family member is upset, and says they do not know when or how the bruising occurred. You have not met the patient before.

What do you do?

Answer 1

Seek information
* Ask about the location and description of the bruising.
* Determine any additional context from the nurse’s observations.
* Check for a background, including vulnerability status and any predisposition to bleeding.

Patient safety
* Speak to the patient sensitively and privately, possibly with the nurse present.
* Reassure the patient, explaining that your priority is their safety and well-being.
* Ask about the bruising and how it may have occurred.

Examine the Patient:
* Look for the bruises and other potential injuries (e.g., wounds, head or bony injuries).

Escalate and Act:
* Discuss findings immediately with your registrar to assess risks and ensure the patient’s safety.
* Involve medical photography if documentation of injuries is required.
* Assess for other forms of abuse and ensure safeguarding by involving social services and filing a safeguarding referral.

Question 2

Following your assessment of the patient, and discussion of the case with your registrar, you suspect this bruising may represent abuse. The patient has a background of dementia, and you are not sure they will be able to consent to the safeguarding referral. What do you do?

Answer 2

• Formally assess capacity
• If not, best interest > involve MDT and those close to them

Question 3

What types of abuse are there?

Answer 3

There are different forms of abuse and neglect:

• Sexual abuse
• Physical abuse
• Psychological abuse
• Domestic abuse
• Discriminatory abuse
• Financial abuse
• Neglect

Question 4

The patient’s family member is unhappy with their treatment during admission and would like to make a formal complaint. What would you say to them?

Answer 4

What Would You Say to the Family Member?
* Listen to their concerns in a non-judgemental way.
* Explain that making a formal complaint is their choice and signpost them to PALS (Patient Advice and Liaison Service).
* Provide a PALS leaflet if available.
* Explain that PALS can help resolve issues informally before a formal complaint is made.
* Ensure they understand the process for preventing recurrence, including incident reporting to learn from mistakes.
* Offer to ask the registrar or consultant to speak with them, apologise, and address further questions.

What Happens If a Formal Complaint Is Made?
* The issue is investigated.
* The patient will receive a written response, including the findings, an apology, and actions taken as a result.

Question 5

What happens if a complaint cannot be solved initially?

Answer 5

If the patient is unhappy with the response, the unresolved complaint must be referred to an independent group outside the NHS- The Parliamentary and Health Services Ombudsman.