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Addressing the deteriorating condition of a rest home resident (09HDC01974)

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(09HDC01974, 21 June 2012)

Rest home ~ Clinical nurse manager ~ Registered nurse ~ Admission process ~ Fluid balance ~ Monitoring ~ Assessment ~ Timeliness ~ Communication between staff ~ Documentation ~ Staff oversight ~ Competence concerns ~ Standard of care ~ Rights 4(1), 4(2)

A daughter complained about the care provided to her 84-year-old mother by a hospital-level rest home in the four days in which she was a resident there. The woman had chronic renal failure, a long history of urinary tract infections, and only one kidney. She was transferred to a new rest home from her local rest home, as her needs had increased to the point where hospital-level care was required.

The woman was not adequately assessed when she was admitted to the rest home and a care plan was not completed. Over a four-day period the woman became dehydrated and her health deteriorated significantly. Although concerns about the woman's oral intake were clearly documented by caregivers on several occasions, the registered nurses denied being aware of such concerns. A fluid balance chart was commenced but poorly filled out. There was no documented evidence of registered nurses assessing the woman or acting on signs of deterioration in her health status.

The woman was admitted to hospital on the fourth day, where tests confirmed that she had a urinary tract infection and acute on chronic renal failure (secondary to dehydration). Sadly, the woman died a few days later.

It was held that the woman did not receive an appropriate standard of care while she was a resident at the rest home.

The Clinical Nurse Manager (CNM) failed to ensure the woman's initial assessment and care plan were adequately completed. The CNM commenced a fluid balance chart but did not ensure other staff knew it had been commenced. The CNM also failed to adequately oversee the clinical care provided to the woman by the nurses and caregivers. Accordingly, the CNM breached Rights 4(1) and 4(2) of the Code.

The owner of the rest home failed to ensure that its staff provided quality care to the woman and complied with the relevant policies and procedures in place at the rest home. It also failed to respond appropriately to serious concerns identified with the CNM's performance. The owner of the rest home breached Right 4(1) of the Code.

Adverse comment was made about a registered nurse's failure to respond appropriately to concerns raised by the woman's daughter about the woman's deteriorating health.

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