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Medication administration and seizure management in patient with brain injury (12HDC01495)
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(12HDC01495, 30 April
Residential rehabilitation service ~ Psychiatric services ~
District health board ~ Brain injury ~ Medication non-compliance ~
Seizures ~ Rights 4(1), 4(5)
A man suffered a traumatic brain injury and developed post
traumatic epilepsy causing seizures. Initially, the seizures were
successfully managed with medication in the community. However,
following a further brain injury, the man became non-compliant with
his medication, suffered a number of seizures, developed psychotic
symptoms, and psychiatric services became involved in his care.
The man was initially treated compulsorily as an inpatient at a
district health board's inpatient services. He was later
transferred for ongoing compulsory residential rehabilitation
services, and remained a resident until his death. He was a
difficult client to manage due to his complex care needs and his
challenging and aggressive behaviour.
The man's non-compliance with his medication escalated. When he
was non-compliant with his medication, he would suffer from
increased seizure activity and aggressive behaviour. He was
admitted to the inpatient unit at another district health board
after experiencing a grand-mal epileptic seizure precipitated by 15
days of non-compliance with his medication. Following two
documented events of aggressive behaviour towards nursing staff and
medication refusals, a decision was made to temporarily administer
his medications surreptitiously by crushing them and giving them to
him in his food or drink.
The man was discharged back to the residential rehabilitation
service, and his medication continued to be administered to him
surreptitiously. He continued to experience seizures and, one
morning, was found dead in his room after having suffered a seizure
at 11:50pm the previous evening.
It was held that there were shortcomings in the residential
rehabilitation service's care planning and documentation. In
addition, instructions to staff on how to administer and manage the
surreptitious administration of medication, and how to manage and
respond to his seizures, were inadequate. There was also no
evidence that the plan to administer his medications
surreptitiously was ever reviewed. The documentation of his seizure
activity was suboptimal, and staff failed to ensure that
recommended tests and medical reviews were carried out.
It was also held that the residential rehabilitation service
failed to co-ordinate and oversee the man's care, and that there
was a lack of a cohesive approach to coordinate care consistent
with his needs. The service breached Rights 4(1) and 4(5).