North Shore Hospital report - New Zealand Doctor

Health and Disability CommissionerMs Wood advised that if ECC staff had assessed Mrs E according to NEWS, herobservations would have been taken two hourly from her arrival.Although the admitting house officer recorded that Mrs E had ―tachypnoea‖ (rapidbreathing) on admission, her respiratory rate was not recorded. The house officer‘sobservations were available to the nurses in the clinical record but they were nottranscribed onto the observation chart to assist in monitoring any trend. Ms Woodadvised that it would be expected that regular, systematic observation of Mrs E‘s vitalsigns would be done until her respiratory rate returned to normal and was stable for aperiod of time.The North Shore Hospital ECC is staffed to try to provide one nurse to four patients.The DHB advised that at the time that Mrs E was in ECC, 206 patients wereprocessed in 24 hours. She was in the Acute Zone (where all patients are initiallyreceived). An ECC nurse reported that staffing in this zone was usually three nursesfor anywhere from 12 to more than 20 patients. Ms Wood commented that thisexceeds the nursing workload that would be expected for similar patients on thewards.Ms Wood advised that the staffing was not based on predictable patient numbers. Itwas based on orthodox bed spaces in ECC and did not include corridor beds routinelybeing used for patients who were ready for transfer to wards but ―blocked‖ becausethe hospital was full. Additional nurses had been budgeted for but there had beenrecruitment difficulties.The DHB had only one nursing vacancy in ECC when Mrs E was there, and it was notin the Acute Zone. However, Ms Wood considered that there had not been sufficientplanning to ensure the number of nurses on each shift was enough to meet demand.Additional cover was not built in during the recruiting period to manage the workload.Ms Wood advised that this would not meet the sector standard requiring thatconsumers ―receive timely, appropriate and safe service from suitablyqualified/skilled and/or experienced service providers‖. 68Waitemata DHB stated that staff make every effort to respond in a timely manner to apatient‘s request for assistance, and apologised if this was not the case for Mrs E.Waitemata DHB submitted that it is unclear whether there was undue delay in Mrs Ereceiving the intravenous fluids because, although the time the fluids werecommenced is recorded as 7pm, the time the doctor ordered the fluids is not recorded.Her intravenous fluids were not initiated earlier because she did not display anyclinical signs of an urgent need for replacement fluid.ECC medical careThe DHB advised that the total number of patients seen at North Shore ECC on17 October 2007 was higher than average. Mrs E was one of 118 triaged as category3. This meant she should have been seen by a doctor within 30 minutes. She was seen68 Health and Disability Sector Standards (NZS 8134:2001), Standard 2.7.52April 2009