Suspected stroke 'went unnoticed'
A rest home has been found to have breached its code of care after a 93-year-old woman may have suffered a stroke that went unnoticed in the days leading up to her death.
A rest home nurse however, has been cleared of any wrong-doing in the care provided to the woman known only as Mrs A.
In a decision released by Health and Disability Deputy Commissioner Tania Thomas, the rest home, the details of which have been suppressed, was found to have breached some rights Health and Disability Services Consumers' Rights Code when it was found there was a "lack of skill in the service provided" to Mrs A.
Mrs A was a long-term resident at the rest home and had a number of chronic health issues. From March to May in 2009, she had repeated problems with serious rectal bleeding - a common side effect of some heart medications, which thin the blood.
Mrs A was hospitalised twice in those months.
The rest home in question offered rest home care, dementia care and hospital-level care for 180 residents, and other accommodation for more independent residents. Mrs A was in the area which provided hospital-level care.
In June that year, she was treated for a urinary tract infection but her condition deteriorated rapidly and over the first six months of 2009 she lost more than four kilograms in weight.
Thomas said Mrs A's son from that point on asked nursing staff at the rest home on several occasions if he could speak to a doctor about his mother's condition but his requests were never passed on.
A doctor - Dr C - finally assessed Mrs A on June 27 and asked whether she had had a "cerebrovascular accident or a trans-ischaemic attack".
A cerebrovascular accident, or stroke, occurs when blood flow to the brain is interrupted. A trans-ischaemic attack is commonly known as a mini-stroke.
Mrs A was reviewed by a second doctor the follow day, who advised her heart medication should be withheld. She deteriorated rapidly and while her family called for a full medical review, they were advised the rest home did not have after-hours medical cover and she would have to go to hospital.
Mrs A's daughter-in-law, who was a GP, told the rest home it was not appropriate for her to be shipped to hospital and arranged for a doctor herself to visit Mrs A in the rest home.
That doctor also considered she may have had a mild stroke in the past, but was only able to prescribe her morphine and antipsychotic medication. The following day, Dr C reviewed Mrs A's condition and told the family her condition was terminal. All medications except the morphine were stopped and she died later that night.
In his findings, the commissioner said the rest home breached the expected standard of care after it was revealed there were problems with communication between nurses, as well as between nurses and doctors.
A clinical support registered nurse (CSRN), who was charged with the care of Mrs A in her final two months, did not breach any codes, Thomas found, but her care "could have been better".
"However, the extent to which her workload and available support impacted on her ability to provide services of an appropriate standard is unclear."
There were two CSRNs employed by the home, who each cared for 90 patients across three separate areas.
- © Fairfax NZ News
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