North Shore Hospital report - New Zealand Doctor

Health and Disability Commissioner3) Possible lack of empathy from nurses to family following [Mrs C‘s] death (subjectiveand unsubstantiated).[Mr D] (dec)Executive Summary:[Mr D] was admitted to ward 11 at North Shore Hospital from 20 September to 18 October2007 with complex medical needs including a heart condition, anxiety and hyperventilation.His family have complained about the lack of information given to them about his condition,prognosis and treatment plan. They received different information about his condition fromdifferent staff and there was confusion about whether he was for rehabilitation or whether hiscare should have been palliative. The family believe that he should have been treated as apalliative patient and provided with more effective pain relief to alleviate his suffering. Therewas a lack of continuity and co-ordination in relation to his care. They are concerned about ageneral lack of compassion and timeliness displayed by nursing staff. [Mr D] died fromcomplications from a punctured lung, possibly incurred during a biopsy procedure he receivedwhile in hospital.Specific Complaints:1) Lack of information about condition, prognosis and treatment plan.2) Should have had more effective palliative care.3) Lack of compassion and timeliness from nursing staff.Expert Advice Required:Please comment on the standard of care provided to [Mr D] in Ward 11. Explain whatstandards apply and whether they were complied with. Please include comment on:a) the appropriateness of the care provided by medical staffb) the management of [Mr D‘s] chest aspirationc) the appropriateness of the care planning for [Mr D] in relation to his anxietyd) the appropriateness of the plan to discharge [Mr D] on 18 October 2007e) the adequacy of the communication and information sharing with [the family]f) the co-ordination of [Mr D‘s] care by medical staff.Standards of care that apply have been documented at the beginning of this report. As is oftenthe case in these situations it is difficult to be absolutely certain of the sequence of events asthey differ considerably between the case notes and the family perception of care. A very fullsummary has been sent to the HDC by WDHB, and this outlines the progress of care in whatwas a very difficult management in an elderly man with numerous co-morbidities who over aperiod of weeks, continued to deteriorate despite ongoing medical attention.Comments from the family outline many perceived problems, both in nursing and medicalmanagement. Some of these in nursing included slowness to answer the bell, poor access tothe bell and fluid, lying in bed which was wet for a long period of time, cold and callousnurses (although interestingly four favourites were mentioned), infrequent turning, hygiene ofthe ward and infrequent eye drops. Despite copious comments from the WDHB it is difficultto completely refute some problems with nursing care, possibly related to the shortage ofhealthcare assistants and extreme workload.Although the family complained of lack of information about [Mr D‘s] condition, prognosisand treatment plan, there are many notations in the progress notes that such information wasgiven. On 16/10/07, according to the report from WDHB dated 26 February 2008 (Pg 32) and138April 2009