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Care of elderly rest home resident with neck fracture (05HDC06957)

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(05HDC06957, 8 December 2006)

Nursing home ~ Cervical fracture ~ Philadelphia collar ~ Care plans ~ Nutritional and fluid intake ~Medical review ~ Standard of care ~ Rights 4(1), 4(2), 4(3)

A woman complained on behalf of her family about the inadequate care her late mother received at a rest home. The woman alleged that the rest home did not manage her mother's cervical fracture and fluid and nutritional needs appropriately.

The elderly woman sustained a cervical fracture in a fall at home. She was admitted to hospital where she received conservative treatment and was given a Philadelphia collar to immobilise her head and neck. Whilst an inpatient, she experienced difficulty eating and swallowing, and lost 3kg in a week. In light of her frail condition and high needs, she was transferred to a private hospital facility for long-term care.

Although the hospital required her to wear her collar 24 hours a day for three months, this was not clearly specified in its discharge instructions. Following her admission to the rest home, her nursing requirements were not documented in a comprehensive care plan despite the rest home's care planning policy stipulating the need to do so.

The woman's health continued to decline. She suffered a stroke and experienced sleeplessness and ongoing pain from wearing the collar, and had pressure areas in her neck, cheek and sacrum. As a result of swallowing difficulties, her nutritional and fluid intake were low, and she lost another 3kg. Staff were instructed to administer subcutaneous fluids, but were unable to do so as the rest home did not stock a giving set. It was ordered and delivered two days later. Shortly before it arrived, the woman was re-admitted to hospital for re-hydration and review, and died a short time later.

It was held that several aspects of the rest home's care were inadequate, namely the absence of detailed care plans to guide staff in their care of the woman, thereby breaching Rights 4(1) and 4(2) despite having appropriate care planning policies in place. In addition, the rest home breached Rights 4(1) and 4(3) by failing to request a medical review for her, and not stocking a giving set to administer fluids.

This case highlights the importance of formulating comprehensive care plans when a patient with complex needs is admitted into a nursing home for long-term care. Without adequate care plans, it is difficult for a nursing home to manage a resident's care proactively. The case also highlights the importance of maintaining a sufficient quantity of all necessary equipment on site, and recognising when to refer a resident to a specialist.

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