North Shore Hospital report - New Zealand Doctor

Health and Disability Commissioner[The on-call house surgeon] was aware of [Mrs B‘s] medical situation having admitted herwhen she first came to hospital.He was on-call the afternoon of 14 July and was asked on several occasions (as documented)to see [Mrs B]. He was aware she had been fully reviewed in the morning.In Summary:The only deficiency was delay in assessment, but with some mitigating circumstances. Tomaintain appropriate standards, this patient should have been seen earlier.[Mrs C] (dec)Executive Summary:[Mrs C] was referred to North Shore Hospital by her General Practitioner on 25 September2007. [Mrs C] had been suffering from a virus and had developed symptoms of fluid retentionand an erratic pulse. She remained in ECC for four hours before being transferred to ward 10.…[Mrs C‘s] family are concerned about the services she received in ward 10. They believe thatstaff did not respond in a timely fashion to a dramatic change in their mother‘s condition,following the administration of Codeine. They believe a lack of continuity of nursing staffwas a contributory factor. In addition, the period between nursing observations on the day ofher death was too long. The family are also concerned about the information they receivedand are disappointed that the seriousness of their mother‘s condition was not conveyed tothem. Communication they received from nursing staff, after their mother‘s death, wasupsetting and displayed a lack of compassion.Specific Complaints from family:1. Lack of response from nurses when [Mrs C‘s] condition deteriorated (followingcodeine).2. Lack of continuity of nursing staff.3. Poor communication regarding seriousness of condition.4. Lack of empathic communication post death.Expert Advice Required:Please comment on the standard of care provided to [Mrs C] in ward 10, North ShoreHospital. Explain what standards apply and whether they were complied with. Please includecomment on:a) the appropriateness of the management of [Mrs C‘s] medicationb) the appropriateness of [Mrs C‘s] treatment planc) the adequacy of doctors‘ communication with [Mrs C‘s] family.[Mrs C] was admitted to ward 10 on the evening of 25 September 2007 after transfer from theECC. Diagnosis was of congestive heart failure. She had a comfortable night and was seen by[the Clinical Director of General Internal Medicine] on the post acute ward round the nextmorning. Treatment for CHF continued (oral frusemide only), and an interesting commentregarding her clinical acuity was made ―Aim home Saturday morning‖ — (three days‘ time).This suggests there were expectations of significant improvement over that period of time.Although there has been a suggestion that clinical deterioration was in response to codeine, Ithink this unlikely, as she was seen on 27 September 2007, and noted by [the medicalregistrar] to be ―feeling lousy‖. The codeine was charted first on the 27 September, and136April 2009