North Shore Hospital report - New Zealand Doctor

Health and Disability CommissionerIt is usual practice for the next of kin to be identified and generally for communication to gothrough that person unless they request specific communication with other family members.At interview [Mrs C‘s] daughter said she had a discussion with a nurse on 27 September whenher mother was ―Dolalee‖, about informing her sister [overseas] regarding her mother‘scondition. She thought this was a dramatic change in her mother‘s condition, and her sisterwanted to attend if her mother became very sick. The nurse was reported to have said shewould ring the next day after the doctor‘s round. (The nurses on both AM and PM noted [MrsC] was ―for ? D/C Saturday as per plan‖ as did the doctor on 27 September AM round.)It would be expected with such a request being made, the nurse would establish the historyand salient facts behind such a request. With informed choice by clients/family/whanau as afundamental principle in healthcare, and processes in nursing, the profession would expect thenurse to affirm with [Mrs C] the need to call the daughter [overseas], and if [Mrs C] was notable to make such a decision, to have an informed discussion with the next of kin and respectthe next of kin‘s decision. [Mrs C‘s daughter] indicated such a conversation did occur withher and the decision was to defer the call until after the medical round the next day. [She] didnot indicate if she was dissatisfied with the outcome. There was no evidence in the patientrecord to indicate the nurse spoke with [Mrs C] about her daughter‘s request to call her sister[overseas] later in the PM shift when she improved.[Mrs C‘s daughter] was called in the night to be told ―your mother has died‖. Calling familywith such news is very difficult. It was acknowledged in the investigation that this is a verychallenging area of practice. [The medical registrar] and [a] Nurse reported at interview staffdo not receive preparation in how to give bad news. This would not be unusual as manyhospitals generally do not provide training in this area.[Mrs E][Mrs E] was admitted to North Shore Hospital ECC on 17 October 2007 by her GP forassessment and treatment for shortness of breath. She was transferred to a medical ward, ward10. The complaint alleges there were delays in providing her with care, and that there was ageneral lack of nursing assistance and ward hygiene.My instructions were to comment on the standard of care provided to [Mrs E] by ward 10North Shore Hospital, explain what standards apply and whether they were complied with,and include comment on:a) the appropriateness of the management of respiratory problemsb) the appropriateness of the management of hygiene standards in ward 10.Supporting information assisting in the provision of this reportGeneral Practice referral letter 17 October 2007St John report 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 1–5 (2 charts)Fluid Balance (2 charts)Nursing Documentation of careIndividualised Falls Intervention Care PlanPatient Handling ProfileClinical NotesSocial Work Initial Assessment[Mrs E‘s] letter of complaint to HDC dated May 2007Interview notes [Registered nurse]90April 2009