North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742waited to be taken to the toilet, and then waited to have her IV reconnected whenshe returned to her bed.There is evidence of a lack of adequate nursing supervision. In Mrs E‘s case thereis no evidence that the enrolled nurse caring for her was appropriately supervisedand was consulting the registered nurse. In Mrs B‘s case, the bureau nurse appearsto have been working largely unsupervised. Her comments indicate that this wasnot unusual and the evidence suggests it was largely related to staffing andworkload. Communication was a significant issue in the cases of Mrs B, Mrs C and Mr D.Nursing staff should have accorded more urgency to communicating with Mrs B‘sson after the doctor‘s review on the night she died. They knew that her son wantedto be closely involved in his mother‘s care. He was denied the opportunity to seeher again before she died.The information provided to Mr D and his family about his condition andtreatment plan was not clear or consistent. The family believed he was dying andwere angry that medical staff appeared to want to rehabilitate him. The DHB hasacknowledged that the term ―rehab‖ was not a helpful one to use given Mr D‘scondition.There was some poor communication between nursing staff and Mrs C‘s family,particularly in relation to her death. These are difficult conversations and greatcare and compassion is needed. Staff need good training in how to communicate―bad news‖ sensitively and empathetically.Hygiene and amenities Cleaning in ward 10 was inadequate. The infection control systems, such asreplacing antiseptic and disinfectant in the toilets, and providing hand-wipes in themeal trays, broke down. The ward was not cleaned until after lunch, allowingrubbish and dirty, wet linen to accumulate. Good hygiene is fundamental to thecare of patients in hospital. It is an issue of safety, comfort and respect forpatients.Because of a lack of towels and nurses, Mrs E had to sponge herself in the toiletusing paper hand towels after her night sweats on 18 October. Cold and wet, shewaited a long time in the early hours of the morning before her bed linen waschanged.SummaryMrs B, Mrs C, Mr D and Mrs E did not receive an appropriate standard of nursingcare, consistent with their needs, while they were on the medical wards at North ShoreHospital. Nursing staff failed to take a systematic approach to assessment, planning,evaluation, and documenting care; did not use the NEWS process appropriately; andfailed to communicate appropriately with the patients and their family. In Mrs E‘scase the hygiene standards were not up to scratch. This was disrespectful to her andother patients on ward 10. Mrs E should not have suffered the indignity of having toclean herself in the toilet with paper hand towels.April 2009 67