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Failure to address deteriorating condition of rest home resident (03HDC14664)
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(03HDC14664, 23 February
2005)
Rest home ~ Registered nurse ~ Caregiver ~
Diabetes ~ Blood sugar levels ~ Monitoring ~ Management plan ~
Staff training ~ Staff oversight ~ Guidelines ~ Responsibility ~
Standard of care ~ Professional standards ~ Vicarious liability
~ Rights 4(1), 4(2)
A woman complained that rest home staff failed to respond
appropriately to her 68-year-old diabetic father's deteriorating
condition. The rest home employed a registered nurse manager to
work office hours and to be on call at all other times. Hands-on
care of the residents was undertaken by caregivers who were neither
registered nor enrolled nurses. While the caregivers were
responsible for administering the man's insulin and monitoring his
blood sugar levels, the registered nurse was responsible for
training, monitoring and supervising the care.
During the week before the man was admitted to hospital, his
blood glucose levels had been falling consistently. The evening
before the admission, the man was observed experiencing "some sort
of fit". The senior caregiver on duty telephoned the nurse for
advice, and was told to put cot sides on the bed to prevent a fall.
His blood glucose levels were low, so she gave him a sweet drink.
No further blood glucose readings were taken that night, but a
temperature reading indicated severe body heat loss.
The caregiver on the morning shift was surprised to find the man
snoring, when normally he would be awake. When his blood glucose
level measured low for three readings, the caregiver telephoned the
nurse, who told her to call an ambulance. The man was admitted to
hospital and transferred to intensive care. He died three days
later.
It was held that the registered nurse should have noted the
falling levels and reviewed the patient's diabetes management plan,
and that in failing to provide services with reasonable care and
skill, she breached Right 4(1). By failing to evaluate the
effectiveness of the man's response to prescribed treatments and
interventions, and to take remedial action and/or refer
accordingly, she breached Right 4(2). It was also held that the
advice she offered the caregivers was inadequate. They should have
been given precise guidance on how to monitor and evaluate the
man's condition. In giving advice, the nurse accepts
responsibility for guidance given and therefore assumes a duty of
care. This failure also amounted to a breach of Right 4(2). A
registered nurse in a rest home is responsible for monitoring the
clinical observations taken by caregivers and for providing
appropriate guidance on action. The nurse should take positive
steps to acquire results of observations, and not simply rely on
untrained staff.
The rest home was held vicariously responsible for failing to
ensure that the nurse fulfilled her role as manager, and carried
out appropriate training and supervision.
The nurse was referred to the Director of Proceedings, who
issued proceedings before the Health Practitioners Disciplinary
Tribunal. A charge of professional misconduct was upheld. The nurse
was ordered to practise only under the supervision of a registered
nurse approved by the Nursing Council of New Zealand, and was
ordered to contribute towards the costs of the hearing and
prosecution.
Link to Health Practitioners Disciplinary Tribunal decision:
http://www.hpdt.org.nz/portals/0/Nur0509clfindings.pdf