North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742by the medical team doctor one hour and 30 minutes after presenting at ECC, whichwas considered reasonable given the volume of patients that day.Dr Ardagh advised that although Mrs E had prompt initial nursing care in ECC,definitive care for her condition was delayed. IV fluids and antibiotics were notstarted until four hours after her arrival at ECC, the chest X-ray was done six hoursafter her arrival, and prednisone was given nearly seven hours after she arrived. Shespent 10 hours in ECC.Like the other patients in this inquiry (except Mr D), she had arrived with a directreferral to the general medical team for assessment by that team. After they saw herand she was treated, a ward bed was able to be ordered.Dr Ardagh commented that the process for referred, acute general medical admissionswas followed and this meant that Mrs E ―waited in a busy, overcrowded ECC forassessment by the team‖. She would have been distressed waiting in that environmentwith acute exacerbation of shortness of breath, feeling that she had been abandoned orwas being ignored, and knowing she needed treatment of a certain type but having towait before it was delivered.Ward 10 nursing careMrs E also raised concerns about delays in her care, the responsiveness of nursingstaff, and hygiene on ward 10.Ms Wood noted that when Mrs E was transferred to ward 10 (in the early hours of 18October), the care plan was only completed for one shift (the morning shift on 18October). The plan focused on her respiratory issues, but did not reflect her problemsof vomiting and diarrhoea or her concerns about her husband and home situation.Referrals were made to a needs assessor and a social worker, which indicated that thenurses were aware of these issues, but Ms Wood advised that the plan would not meetthe required standard.Ms Wood advised that the DHB‘s Clinical Documentation Procedure states thatprogress notes are to be documented in a logical format starting with generalappearance, observations, treatments, pain, and the various systems such ascardiovascular and psychology. None of the nurses involved in Mrs E‘s care used thisstructured approach.Ms Wood advised that it was appropriate for Mrs E to be cared for by an enrollednurse because she was stable, but it is not recorded which registered nurse wassupervising the enrolled nurse, and there is no evidence of discussion about the care,or that a supervising nurse was consulted about the refusal of treatment (thenebuliser). Nursing Council competencies require registered nurses to supervise andevaluate care provided by enrolled nurses, and provide clear direction. Ms Woodadvised that the care provided did not accord with this requirement.Mrs E‘s intravenous (IV) line was disconnected each time she needed to go to thetoilet, because there was not enough equipment, such as a mobile pole, to keep theline intact when she was out of bed. It was also disconnected when she was moved toApril 2009 53