1. Patient Story

2. Background Young patient with Learning Difficulties Severely autistic and challenging behaviour including self harm Cared for by other family members Presented with extremely heavy bleeding and pain during menstruation. Family requesting a hysterectomy.

3. First Contact Gynae surgeon contacted Head of Safeguarding to ensure process for completing consent for patients who lack capacity. Best Interest Meeting 1 held with surgeon, family member, LD liaison nurse, HoS. Family member explained difficulties with transition from paediatrics to adult services. Very anxious to be heard, felt that no-one listened.

4. Best Interests Decision To examine patient under anaesthetic and consider treatment options. If appropriate complete treatment whilst under anaesthetic. Explained to family member, hysterectomy would not be likely as first choice treatment option. Long term management discussed.

5. Planning Surgeon to meet with patient – large space. 2 nd best interest meeting including ward sister, LD community day support and the rest of the PAHT team. Pathway of care mapped out: including: –Bloods to be taken in community –Photos of ward staff to be taken (with their consent) and community staff to undertake story board work with patient.

6. Planning (cont) –Plan for admission and discharge same day – family member to stay at night if necessary. –Admission during weekend to allow maximum space for patient (panics in small rooms). –Items for patient to bring with her agreed e.g. a bag that she takes everywhere with her. –Traffic Light Passport to be completed –Patient and family member to meet anaesthetist on admission. –Attention paid to post op recovery instructions for grandmother including prescription of pain relief.

7. Admission Day PROBLEM:- refurbishment works on nearby ward likely to upset patient. SOLUTION:- change ward and ensure family member knows so she can prepare patient. OUTCOME:- change of ward managed well, no problems experienced, rest of plan completed to the letter.

8. Grandmother’s response “Thank you to everyone who has ehlped, supported and cared for our xxxxxxxxx, both before, during and after her stay on D1 at the xxxxxxxx Hospital xxxxx. … the care of xxxxxxx whilst undergoing the procedure was without question – remarkable…The outcome for xxxxxxx on the day was all we could wish for and xxx recovery after the general anaesthetic was well controlled thanks to the Dr’s skill and expertise.”