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Care of elderly woman with cervical fracture (05HDC09852)

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(05HDC09852, 28 February 2006)

General practitioner ~ Registered nurses ~ Dementia ~ Rest home ~ Head and neck pain ~ Cervical fracture ~ Documentation ~ Right 4(2)

A woman complained about the care provided to her 89-year-old mother by a rest home dementia unit. The elderly woman complained of head and neck pain, which was only partially relieved by the administration of paracetamol. Her pain was initially reported to one of the rest home's general practitioners, who considered the symptoms to be due to migraine. Three days later she was found to have bruising to her left arm and hip and was having difficulty weight-bearing. Another GP assessed her, queried the possibility of hip fracture, and arranged for an X-ray. The X-ray showed no abnormality. Two days later, she continued to complain of head and neck pain and was referred back to the initial GP. An examination and X-ray identified a fracture of the cervical spine.

It was held that the first GP's documentation fell below professional standards and breached Right 4(2). The second GP was held not to have breached the Code. Although he documented his assessment in the wrong file, and dated the record incorrectly, this did not have any bearing on the delayed diagnosis and, overall, he provided the woman with an adequate standard of care.

It was held that on the two occasions the woman's condition departed significantly from normal, one of the registered nurses noted the change, informed the family and consulted with a doctor. It could be argued that the nurse noted the woman to be in pain over a three-day period without pursuing the cause of the pain more vigorously.  However, it is very difficult to accurately assess pain levels in a patient with dementia. The care provided was appropriate and therefore did not breach the Code.

Another of the registered nurses could have been more proactive in her documentation, but given that the elderly woman was unable to give a clear description of her pain owing to her dementia, her complaints of neck pain were intermittent, and there was no evidence of injury, it was reasonable that she took a "wait and see" approach at that time.  Accordingly, the nurse did not breach the Code.