North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742Ms Wood also noted that there was no care plan for Mrs B despite the DHB‘s ownrequirement for a comprehensive assessment and care plan within 24 hours of heradmission.Although she considered that the ward 11 progress notes for Mrs B adequatelydescribed her care, Ms Wood again noted a failure by nursing staff to have astructured approach to documentation as required by the DHB‘s procedures and thenurses‘ professional organisation. 65Further, Ms Wood advised that it appears from the notes that ward 11 nurses did notcorrectly follow the NEWS process. Mrs B‘s NEWS score was completed three tofour times a day. It fluctuated between 0 and 1. When the recordings triggered a scoreof 1, her observations should have been increased to two hourly, and the nurse coordinatorshould have been informed, but this is only documented once. Thefrequency of Mrs B‘s observation recordings varied between four hourly and twicedaily and did not appear to comply with the NEWS guidelines.Additionally, the DHB had a facility for patients who regularly triggered the NEWSprocess with high scores to be reviewed. This was not used for Mrs B. Ms Woodadvised that the failure to use NEWS systematically would be met with severedisapproval within the nursing profession and would not meet Nursing Council ofNew Zealand competencies.On the morning of 14 July 2007, Mrs B‘s son was concerned that his mother‘scondition was deteriorating. He asked both the morning and afternoon nurses tocontact the doctor, even though his mother had been reviewed that morning. On bothoccasions the doctor was paged, but Mrs B was not seen until 9.15 that night.The nurse caring for Mrs B on the afternoon of 14 July was a bureau nurse. Shesought review by a Clinical Nurse Specialist (who worked with nurses in a coachingrole), who expressed some concerns about Mrs B‘s condition.Two-hourly observations were carried out by the bureau nurse, who also assisted withthe eventual doctor‘s examination, and carried out the subsequent care.Ms Wood advised that there were alternative care options that could have been takenby the nurse as Mrs B deteriorated. Given the Clinical Coach‘s concerns and the needfor medical input, the nurse in charge should have been observing Mrs B andoverseeing the care provided by the bureau nurse.Ms Wood also advised that when the doctor reviewed Mrs B that night the nursesshould have recognised the acuity of her condition from the doctor‘s findings, andinformed her family. There was delay in contacting her son because the nurse did notprioritise communication with him, even though he had already clearly indicated thathe wanted to be with his mother if her condition worsened. He had left the hospital at7.15pm disappointed that the doctor had not seen his mother. He was rung at 10pm65 NZNO Standards for Practice 2.6 and 3.4.April 2009 45