North Shore Hospital report - New Zealand Doctor

Health and Disability Commissionerand problems being treated. She also advised that it is only appropriate when nursingsupply and patient demand match. 61The nursing documentation of Ms A‘s care did not demonstrate the systematicapproach required by the DHB‘s own guidelines or the New Zealand NursesOrganisation (NZNO) Standards for Practice 2.6 and 3.4. 62 Ms A and her partner leftthe hospital with no information about her admission or discharge instructions for therest home for care planning, or for her GP for follow-up. Discharge sections on anAssessment and Discharge Planning form were not completed.Ms Wood advised that there was a lack of continuity, co-ordination, and systematicreview of Ms A, which would be regarded with severe disapproval by the nursingprofession.ECC medical careIndependent emergency medicine specialist Dr Mike Ardagh noted that Ms A did nothave a musculoskeletal examination at the time of her admission. However, this wasnot inappropriate, because it had no relevance to her presenting condition and at thetime she was not complaining of hip pain.Dr Ardagh advised that there is no evidence that ECC medical staff missed thefractured hip (which was found after her discharge and led to her readmission andsurgery). It is likely the fracture occurred on the morning of Ms A‘s discharge (2April 2007), after the final doctor‘s assessment at 11.30am. Fracturing a hip inhospital can happen, as it can at home, and does not necessarily represent poor care.However, sending an elderly patient home with a known fracture would suggest adeficiency of care.Like Ms Wood, Dr Ardagh was critical of the way in which Ms A was discharged.Keeping her in ECC as a ―short stay patient‖ because of bed shortages compromisedthe quality of her discharge. Dr Ardagh commented: ―Her remaining in ECC was aconsequence of deficiencies of process and capacity — processes that demand ECC isused for patients who do not need to be in an Emergency Department, and insufficientbed capacity.‖There was poor communication in relation to Ms A‘s discharge. When Ms A‘s partnerarrived to pick her up that morning, she was not ready and there was a lack of clarityabout what should happen next. Dr Ardagh advised that it is expected that patients aredischarged with adequate information, such as follow-up instructions that include anymedication to be given. Staff should ensure that the patient can manage at home, andelderly patients should be assessed for mobility and daily living capability. There isno evidence that this was done in Ms A‘s case. There is no record that she was able towalk prior to her discharge.61 Having the nurses work as one big team is the approach adopted when there are staff shortages, andwhen other models cannot be used because there is an imbalance of inexperienced and experiencedstaff.62 2.6 ―Apply current nursing knowledge using a documented systematic approach to meet the statedand implied needs of clients/family.‖ 3.4 ―Use an appropriate nursing framework to assess anddetermine client health status and the outcomes of nursing intervention and document appropriately.‖42April 2009