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Inadequate diagnosis and treatment of patient in rest home (01HDC12197)

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(01HDC12197, 25 September 2002)

Rest home ~ Dementia ~ Standard of care ~ Missed diagnosis ~ Right 4(3)

A complaint was made about the care provided by a rest home to a woman with dementia. The complaint was that staff at the rest home failed to: (1) diagnose the dislocation of the patient's prosthetic hip; (2) investigate the source of pain experienced by the patient; and (3) provide adequate treatment for the pain.

The patient had two prosthetic hips and, at some time during her two-year admission to the rest home, she dislocated her left hip. Staff thought the woman's expression of pain was due to her confusion, so she was treated for anxiety and confusion rather than pain. The rest home did not regularly review the woman's physical and cognitive condition, and a full pain assessment was never undertaken. The dislocation was diagnosed on admission to hospital, and the X-ray report suggested the dislocation had been present for some time.

Although it is likely that the woman's expression of pain was subtle, the dislocation would have been detected if there had been regular assessments of her physical and cognitive function. The rest home should have ensured that there were regular physical and mental reviews of the woman's condition and that a pain assessment was conducted.

In view of the woman's medical history, the staff at the rest home should have been more vigilant concerning her physical condition; she was in a very vulnerable situation and relied on health care providers to meet her needs. The rest home breached Right 4(3) in that it did not provide services in a manner consistent with the woman's needs.

The Commissioner recommended that the rest home include the family in three-monthly multidisciplinary reviews of residents, in conjunction with a full medical check.