North Shore Hospital report - New Zealand Doctor

Health and Disability Commissioner6. Delay in care when condition deteriorated, and failure to recognise the extent of theillness.Expert Advice Required:Please comment on the standard of care provided to [Mrs B] in ECC and ward 11. Explainwhat standards apply and whether they were complied with. Please include comment on:a. the appropriateness of the medical assessment and follow-up on the afternoon of 14 July2007b. the adequacy of communication between nursing and medical staffc. the adequacy of communication with [Mrs B‘s] family.Standards of care for all patients admitted acutely to public hospitals are similar for everypatient. They include rapid triage in the emergency setting, transfer to an appropriate facilityfor continuing management, timely nursing and medical assessment, management plansinstituted and good handover when patients transfer from the Emergency Department to theinpatient wards. When in the inpatient wards nursing care should be appropriate as outlined innursing protocols and targeted to individual patients‘ needs.As documented in the extremely thorough response from WDHB to the Health and DisabilityCommissioner on 26 February 2008, [Mrs B] was admitted on 6 July 2007, after a month inhospital [overseas] following a major stroke. Other medical problems included ischaemicheart disease with a documented inferior myocardial infarct in 1999, ongoing ischaemicchanges on her ECG, pulmonary hypertension, chronic renal impairment and poorlycontrolled hypertension.She was immediately Triaged 3 (Australasian Triage Category) and put in a single roombecause of concerns regarding MRSA in a patient coming from an overseas hospital.Handover between the ECC staff and the Air Flight team was performed, documentation fromthe [overseas hospital] was thorough and she was receiving PEG feeding (this was transientlystopped when she was started on IV fluids). Nursing management was appropriate for a strokepatient, and despite comments from the family that she was left lying supine despitebreathlessness, there is documentation that [Mrs B] was elevated when she was noted to bemore short of breath. This notation was transferred to the wards where instructions were givento keep her at least at 30º to aid breathing. She was placed under [the general medicineconsultant‘s] team. I see no evidence of lack of continuity of care — she was admitted by [thegeneral medicine consultant‘s] team, seen by him on three occasions during her stay(including the post acute rounds) and medical documentation of her course was veryadequate.Handover documentation from ECC to the ward is satisfactory, and WDHB have outlined infull the process of handover from shift to shift in the hospital. Certainly the nursingdocumentation which is very thorough shows no evidence of difficulty in understanding thenursing issues. She was seen by the stroke service, Nutrition Service, Allied Health, NASC,OT and SLT. Documentation from all these services is very complete.A concern about having to reiterate [Mrs B‘s] history to numerous staff is something we hearoften. However with so many medical and nursing staff looking after each patient this isunavoidable, and in that [Mrs B] could not respond, it seemed likely that her family would beasked.Over the week [Mrs B] remained in hospital she remained reasonably stable, recognising thecritical nature of her illnesses. It is difficult to assess from the records that there wereinappropriate delays in nursing attention, and a comment that the nurses looked ―stretched andstressed‖ could be directed at every medical ward in major metropolitan hospitals.134April 2009