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Care Of A Deteriorating Patient At A Rest Home

Deputy Health and Disability Commissioner Rose Wall today released a report finding the owner of a rest home in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for providing poor care to a man whose condition was deteriorating.

The man, who was in his nineties, had multiple medical conditions including dementia, heart failure and diabetes. Whilst a resident at the rest home, his condition deteriorated and he began to show signs of pain, infection and delirium. There was a delay in administering antibiotics, minimal opiate pain relief and a failure to test for a UTI. Eventually the man was transferred to hospital where he was diagnosed with suspected blood poisoning and passed away.

Ms Wall considered that the man was let down by various aspects of the care provided to him by numerous staff at the rest home. Oversight of the rest home was provided by nurse practitioners, and there was no means for enabling direct, urgent access to a GP. The prescribing system did not allow for urgent medications to be fast-tracked. Ms Wall criticised the inadequate monitoring and documentation of the man’s condition and the rest home’s poor communication with the man’s family. She was also concerned that the man was transferred to hospital despite the man’s power of attorney having requested comfort cares if the man’s health had declined.

"[The man’s] deteriorating health should have been closely monitored at the time, with a clear plan of care established to ensure that the support provided and the actions of nursing and support staff were well co-ordinated and responsive to his rapid decline," Ms Wall said.

Rose Wall recommended that the former owner of the rest home apologise to the man’s family. Although the rest home had been sold, she recommended the former owner review its national systems to ensure that consistent policies are in place at all of its facilities relating to appropriate prescribing processes and the escalation of care to GPs and on-call GPs. She also recommended that it incorporate various improvements to end-of-life care into its facilities nationwide.

A full version of the report can be viewed on our website

https://www.hdc.org.nz/decisions/search-decisions/2020/17hdc00812/

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