Quake no excuse for poor care
The long hours and trauma among rest-home staff as a result of the February 2011 Christchurch earthquake were no excuse for the suboptimal care of an elderly woman, the Health and Disability Commissioner says.
The woman, aged in her mid-80s, was a resident at Middlepark Rest Home & Village in Christchurch from early 2008 to 2011. Her health problems included depression, hypertension and osteoarthritis.
She had a history of urinary tract infections (UTI) while at Middlepark.
In 2011 her health began to deteriorate, she developed a stomach bug and had vomiting and diarrhoea, deputy health and disability commissioner Theo Baker said in a decision published today.
Two weeks later, a dipstick urinalysis test indicated the woman was suffering from a UTI, but a urine sample was not taken to confirm that. She was started on a course of antibiotics, but not all health providers involved in her care were aware of the treatment.
Over the next few days she had five falls and continued to deteriorate. Incident forms were filled out with incorrect information and were not appropriately signed off. Staff at Middlepark advised other staff the woman was to have palliative care, when no decision had been made.
The woman was admitted to hospital, at the request of her daughters, suffering from pain in her abdomen and confusion. A urine test showed resistance to the antibiotic she had been prescribed at Middlepark.
The woman was diagnosed with urosepsis caused by her UTI and she died a short time later.
One of the woman's daughters said she and her sisters were deeply shattered.
"No words will ever be able to convey the distress to us of seeing, hearing, reading and knowing mum did go through what she did," she said.
In her decision, Baker said Middlepark had not been significantly affected by the February 2011 earthquake and so had temporarily taken in seven hospital-level residents from elsewhere.
Staff said it had been difficult to find staff cover after the earthquake, and they had worked considerable hours for the two weeks immediately afterwards.
Middlepark's clinical leader said she had had to take added responsibility after the quake, and had not been provided with enough support.
"[Middlepark] had staff who were traumatised and we had residents and families who were traumatised," she said.
"We had inadequate equipment and space. We had hospital residents, who we didn't know, with complex needs that we were unaware of and had to find out. Added to all this we continued to experience lots of aftershocks."
Baker said she accepted the effects of the February 2011 quake provided considerable challenges to providers and consumers in the weeks and months that followed.
"However, I do not accept that these difficult circumstances justify the suboptimal care that [the woman] received at Middlepark in 2011," Baker said.
"In my view, that care was the result of both systemic and individual failures that were not directly linked to the earthquake and its effects."
Her main concerns were poor communication among healthcare staff, and between staff and the woman's family, inadequate documentation of the care provided, and the delayed and inadequate treatment of the woman's UTI.
The rest home and several of its staff were found to have breached the Code of Health and Disability Services Consumers' Rights.
Middlepark's owners, Oceania Care Co, failed to ensure appropriate policies and procedures were implemented and followed by clinical and care staff. Staff failed to follow documentation and communication policies, Baker said.
The company said many positive changes had since happened at Oceania and Middlepark to improve resident care.