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Care of rest home resident (02HDC18190)

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(02HDC18190, 28 June 2005)

Rest home ~ Nurses ~ General practitioner ~ Parkinson's disease ~ Pressure sores ~ Monitoring ~ Timeliness ~ Power of attorney ~ Documentation ~ Communication with family ~ Wound management ~ Medication management ~ Rights 4(1), 4(2), 4(4), 6(1), 7(2)

The family of a 72-year-old man with end-stage Parkinson's disease complained about the care he received in a rest home, which was certified to give full-time hospital-level care. Over his five months' residence, the man's health deteriorated significantly, in particular with a worsening sacral wound. He was admitted to hospital, where he died from sepsis.

It was held that the rest home managed the bedsore appropriately in its use of dressings, medications and support aids. However, when the wound was not healing, the rest home should have asked the attending GP to review the wound and the management plan. While a more timely referral was unlikely to have altered the outcome, the delay in doing this did not minimise the potential harm caused by the wound, and breached Right 4(4).

The rest home also breached Right 4(1) in its failure to administer medications with reasonable care and skill. A failure to document injuries caused by a possible fall amounted to a breach of Right 4(2) and risked compromising the man's care in a multi-provider environment where accurate notes are essential to ensure that care is co-ordinated and complete.

It was also held that the rest home failed to provide full and accurate information about the man's condition to the daughter, who had an enduring power of attorney.  As the man's competence diminished, the home was obliged to give the daughter full and accurate information about his condition and treatment options. By not doing so, the home did not observe Right 7(2) and breached Right 6(1). If the rest home had instituted formal family conferences, attended by the home's multidisciplinary team and the range of interested family members, the situation whereby various family members received different pieces of information could have been avoided.

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