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Care provided to rest home resident with dislocated hip (06HDC06457)

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(06HDC06457, 20 August 2007)

Rest home/hospital ~ Dislocated hip ~ Medical services ~ Standard of care ~ Right 4(1)

A woman complained on behalf of her family about the inadequate care her mother received at a rest home. She alleged that the rest home did not manage her mother's dislocated hip appropriately.

Early in the evening, the elderly woman dislocated her hip while standing in her room. She called for assistance for some time. The caregiver who first attended her did not realise that there was a problem with her hip and sat her in a chair. During the course of the evening, staff noticed that there was a problem with the position of the woman's leg. A registered nurse conducted a visual and physical examination, identifying that the hip had dislocated. The registered nurse ensured that the woman was lying comfortably in her bed, offered her pain relief and telephoned the on-call doctor.

The rest home's system of documenting information concerning the on-call doctor was a loose sheet of paper attached to the patient records trolley. Unbeknown to the nurse this information had been changed and the regular doctor was on leave. The sheet of paper recording this information was not attached to the trolley. The nurse left messages on the rest home's regular doctor's answerphone. These calls were not picked up. The elderly resident did not receive medical review for her dislocated hip until the following morning when the error concerning doctor availability was discovered.

The woman's condition was monitored overnight and she was offered pain relief. A locum doctor was called once the error was identified. An X-ray was ordered and this identified the dislocated hip, leading to the woman being hospitalised.

It was held that several aspects of the rest home's care were inadequate, namely that staff were not sufficiently instructed in the woman's history of hip dislocation, or how to manage such an event should it occur. Also, they did not attend her calls for assistance promptly. The inadequate storage of information concerning access to medical on-call assistance meant that the elderly resident did not receive appropriate medical services when required, and the rest home/hospital was found to be in breach of Right 4(1).

This case highlights the importance of providing caregivers with appropriate information on the care of their patients. That information, essential to the provision of medical assistance, should be appropriately stored and accessible to the staff responsible for overseeing clinical care of patients.