North Shore Hospital report - New Zealand Doctor

Health and Disability Commissionerrequirement for registration and has been part of RN practice standards since 2004 (Lesa andDixon, 2007). It is within the Domain Two competencies, Management of Nursing Care.Lesa and Dixon (2007) in writing about physical assessment in nursing practice, note―However, is not without its tensions as there is a large nursing workforce who did not learnphysical assessment as part of their RN preparation, resulting in nursing students and newgraduate nurses practicing in an environment that does not yet promote nurses using physicalassessment (Milligan & Neville 2001). This gap has been acknowledged by the professionand courses are available for RNs to bring their physical assessment skills up to the standardof a present RN graduate‖ (p.166).[The bureau nurse] entered practice at North Shore Hospital a year earlier and competencewould be expected to have been assessed on orientation. If not met, remedial education wouldbe expected to be arranged so that competence could be demonstrated. The nurse reported shehad one day‘s orientation on taking up her position. The organisation would not meet theHealth and Disability Sector Standard (NZS 8134: 2001) 2.7, requires consumers/kiritaki toreceive timely, appropriate and safe service from sufficient suitably qualified/skilled/ and orexperienced service providers, and criteria 2.7.3 requires the appropriate allocation of suitablyqualified/skilled and/or experienced service providers to meet the needs of consumers/ kiritakiin a competent, safe and timely manner.Waitemata DHB provides placements for undergraduate nursing students and its nursing staffwould be expected to model professional practice and to coach contemporary practice tostudents.[Mrs C][Mrs C] was admitted to North Shore Hospital ECC on 25 September 2007 by her GP, forassessment and treatment for fluid retention and an erratic pulse. She was transferred to amedical ward, ward 10 where she continued to deteriorate. The complaint raises concerns that[Mrs C‘s] vital signs were not adequately assessed, she had a reaction to medication that wasunrecognised by staff, and the seriousness of her condition was not communicated to herfamily. [Mrs C] was found unresponsive at 12.20am on 27 September 2007 and death waspronounced.My instructions were to comment on the standard of care provided to [Mrs C] by ward 10North Shore Hospital, to explain what standards apply and whether they were complied with,and to include comment on:a) the appropriateness of the nursing observationsb) the adequacy of nursing documentationc) the appropriateness of the information sharing and communication with [Mrs C‘s]family.Supporting information assisting in the provision of this reportGeneral practitioner referralSt John report formNSH Fax Handover FormPatient Registration FormECC Assessment pages 1–6Admission and Discharge Planner pages 1–12Observation Chart and North Shore Early Warning System (NEWS) pages 1–4Medicines chart pages 1–5Fluid Balance (2 charts)Clinical NotesComplaint to HDC by [Mrs C‘s] daughter dated October 200784April 2009