North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742the outcomes of nursing intervention and document appropriately‖ (p.12), and the registerednurse competency 2.2 (Nursing Council of New Zealand 2005).The NEWS referral process would require the nurse in charge of the shift to be notified of therespiratory rate of 44, and to provide advice. Given the nurse caring for [Mrs B] was from theBureau, the concern of the Clinical Coach at 4.30pm and the need for a medical consultation,the nurse in charge should have been observing [Mrs B] and the nurse throughout the shift.The shift co-ordinator‘s tracking of the medical consult and specific advice to the nurse wasnot in the record, and action was not mentioned at interview. The nurse in charge should havebeen informed of [Mrs B‘s] vital signs recorded by the house surgeon as per the NEWSscoring and to follow through on the required care to meet the shift leader responsibilities andthe Nursing Council Competency ―1.3 Demonstrates accountability for directing, monitoringand evaluating nursing care that is provided by nurse assistants, enrolled nurses and others.‖The adequacy of the information sharing and communication with [Mrs B‘s] family[Mrs B‘s son‘s] account of his communication with the nurse on the morning shift indicatedhis concern about his mother‘s condition. The nurse‘s note indicates she followed through bypower-paging the on-call house surgeon.[The son] requested the afternoon nurse to arrange for him to see his mother‘s doctor. Thenurses called the on-call house surgeon and requested he attend. They followed the requestup. They endeavoured to meet [his] request. The nurse rang him when the doctor had been.The communication when [Mrs B] was in pulmonary oedema was delayed because the nursedid not prioritise the communication with her son. The significance of the clinical findingsand the potential trajectories were not foreseen by the clinicians. Regardless of the clinicaloutcome, [Mrs B‘s son] had made it clear he wanted to be with his mother (he had come inpreviously when she experienced acute heart failure) and this was possible.[The son‘s] concerns about the bell not being answered in a timely way, is a widespreadconcern in hospitals. Delays in answering bells are common but not acceptable. In my opinionthere is a systems issue to be resolved in order to have bells answered in a timely way in abusy hospital. For the nurses, the bell rings in the corridor, and to see if it is their patientringing they all have to stop what they are doing to go out in the corridor and see the belllocator which displays the room number. There is diffuse undifferentiated constantinterruption to all nurses‘ complex work. This is common in old bell systems. This is similarto doctors being interrupted by pagers and is a patient safety issue (Agency for HealthcareResearch and Quality, 2003). Tauranga‘s new hospital has a new bell system connected topagers. When the patient or family rings the bell it rings directly to the right nurse‘s pager. Ifshe/he does not answer in the programmed timeframe, the nurse in charge is automaticallypaged. This sort of system would have addressed [the son‘s] concern about delayed answeringof bells.The adequacy of communication between nursing and medical staffIn the section above, the contacts between the staff are described. The nurses communicatedas required and passed on the information as they knew it. The on-call house surgeonprioritised his work based on the nurses‘ assessment. The rehabilitation ward is some distancefrom the other wards and he reported he had many patients to see who he believed, based onthe information provided, he needed to see first. The information could have been much richerif a comprehensive focused assessment was completed.Physical examination skills have been taught in some undergraduate nursing schools since1990 and all schools since 2001. In 2001 the KPMG report ―Reach further‖ to the NursingCouncil of New Zealand recommended the ―development of nursing assessment skills be acritical area for emphasis within the undergraduate curriculum‖ (Nursing Council website,p.11). Physical examinations is part of the undergraduate curriculum, is now a practiceApril 2009 83