North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742initiating protocol treatments, keeping patients safe until they are examined, andimplementing treatment plans promptly, requires a level of staffing to ensure responsiveness,taking into account the variable skills mix of some experienced, junior or casual staff.Given the RN skill mixes in the ECC, the other factor to take into account is WaitemataDistrict Health Board‘s responsibilities in its contract with the Clinical Training Agency forthe Nursing Entry to Practice Programme. The requirements to be met are laid out in theNursing Council Standards for the Nurse Entry to Practice Programme. In particular StandardFour states the ―Appropriate resources are available to support the programme….Criterion4.3. The programme is appropriately supported in terms of time allowance for preceptorsworking with the new graduates‖ (p.5).It is not unusual for the nurse in charge who is providing the care plan direction to registerednurses in any setting, not to document their direction. This is generally because they allocatepatients to specific registered nurses who then take the care forward, reporting in changes orwhen they need guidance. However, in Team Nursing the nurse is taking responsibility fordirecting rather than allocating care. As described by the nurses, the ECC whiteboard holdssignificant nursing care planning by the Team Leader that needs to be captured in thepatients‘ notes. This lack of documentation of care does not meet the New Zealand NursesOrganisation (2003) standard which states ―provide documentation that meets legalrequirements, is consistent, effective, timely accurate and appropriate‖ (Standard 1.10), northe Nursing Council of New Zealand (2005) competency 2.3 which says ―maintains clear,concise, timely, accurate and current client records within a legal and ethical framework‖.None of the nurses used a structured approach to document their progress notes. WaitemataDHB Clinical Documentation Procedure states progress notes are expected to be documentedin a logical format and an example is provided ―e.g. SOAP‖. The Waitemata District HealthBoard Orientation Workbook for the Acute Medical Wards promotes a systems approach toprogress notes starting with ―General appearance; observations; treatments, Pain,Cardiovascular; Respiratory; Genito-urinary; Gastro-intestinal; Neurological; Skin; MentalHealth; Musculoskeletal; Psychological‖. The content of the note should include: ―AIR(assessment/intervention/response) or DAR (data/action/response)‖. This procedure was notfollowed in any report during [Ms A‘s] stay.The documentation of all the nurses was without a systematic approach related to the patient‘sneeds as required in the New Zealand Nurses Organisation Standards for Practice 2.6 ―Applycurrent nursing knowledge using a documented systematic approach to meet the stated andimplied needs of clients/family‖ (p.8), 3.4 ―Use an appropriate nursing framework to assessand determine client health status and the outcomes of nursing intervention, and documentappropriately‖ (p.12), 4.9 ―Be a role model to colleagues, students, health professionals andothers‖ (p.17) and the registered nurse competency 2.2 (Nursing Council of New Zealand2005).[Mrs B][Mrs B] was admitted to North Shore Hospital Emergency care centre (ECC) on 6 July 2007via Auckland airport after suffering a severe stroke (with complete right sided flaccidparalysis) while on holiday [overseas]. This left her unable to speak. At some point in thetransfer to New Zealand, [Mrs B] suffered an acute myocardial infarction. She was assessedin the ECC, and while waiting for an inpatient bed, experienced an acute episode of heartfailure which required intervention with IV frusemide. [Mrs B] was admitted to a medicalward, ward 11.On 14 July [Mrs B] went into respiratory distress. The complaint alleges that there weredelays in [Mrs B] receiving care and obtaining review by on-call medical staff, despiterequests from her son. [Mrs B] was found dead at 10.15pm on the evening of 14 July 2007.April 2009 77