North Shore Hospital report - New Zealand Doctor

Health and Disability Commissionerabout a possible reaction to codeine, the infrequency of nursing observations, the slowness torespond to family concerns, and the inadequacy of communication of the gravity of thesituation.I have read the patient records and all of the statements from staff. I appreciate [Mrs C‘s]family‘s concerns about frequency of interactions, and responsiveness of staff. Both of thesecomplaints feature prominently in the other cases under investigation. Although it is difficultto be certain, as details of such matters are not easily obtained and the statements do notconfirm all of the concerns, it seems likely that frequency and timeliness of interactions couldhave been better, and that workload may have contributed to this. [Mr D][Mr D‘s] case is complex, and the distressing nature of his final days must have been verydifficult for his loved ones. All of their concerns relate to the care while on ward 11 and thereare specific concerns regarding aspects of nursing and medical care. These concerns areoutside my brief. However, complaints also relate to communication, the frequency ofinteractions, and responsiveness to concerns. Clearly communication between loved ones andstaff was difficult at times, and possibly interactions were slow and infrequent as suggestedby the complaints, (although I cannot say for sure, as staff statements contradict thecomplaints). However, if there were deficiencies, and in keeping with similar concerns raisedin the other cases under review, it is likely that the workload of staff contributed. [Mrs E][Mrs E], after leaving the ECC, was admitted to the ward, where she continued her treatmentfor an infective exacerbation of chronic airways disease. In the ward she had concerns similarto those voiced regarding the ECC cleanliness and responsiveness. I have read theaccounts from the staff in response to [Mrs E‘s] concerns, and appreciate that measures havebeen put in place to improve both of these. The employment of more Health Care Assistantsis part of the solution to timeliness of response when the nursing staff have multiple calls torespond to.Although there are some specific issues related to cleanliness, other than these I am of theview that the difficulties [Mrs E] encountered on the ward were a consequence of the nursingstaff being overwhelmed.Response to Questions 3–6: Please comment generally on the systems and policies inplace at Waitemata DHB between April and October 2007 to ensure patients receivedappropriate and timely care. In particular:a) contingency planning with respect to bed availabilityb) the adequacy of systems in place to facilitate patient flow through the hospitalc) any other factors impacting on patient flow and hospital capacityd) the predictive models and reporting systems used by the DHB.Please comment on Waitemata DHB’s initiatives designed to improve patient flow andhospital capacity.Please provide any recommendations for improvement.Are there any aspects of the care provided by Waitemata DHB that you considerwarrant additional comment?Since the events related to this investigation Waitemata DHB has made a number of changesintended to improve the functioning of the ECC, the flow of patients through their hospitaljourney, and the care of patients while there. These changes include:122April 2009