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Monitoring of respite rest home patient (09HDC02159)
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(09HDC02159, 27 January
Rest Home ~ Registered nurse ~ Nursing team leader ~ Respite
care ~ Norovirus outbreak ~ Dehydration ~ Monitoring ~ Care and
skill ~ Right 4(1)
This case highlights the need for rest homes to have adequate
systems in place to recognise when a patient is deteriorating so
they are able to respond promptly and appropriately. Safety
measures need to be in place to ensure the patient receives
adequate care and monitoring. Monitoring supported by clear,
regular documentation can provide important clues about a patient's
changing status. It is especially important when there are several
people providing care to the same patient.
The daughter of an elderly lady complained about the care her
mother received when she was admitted to a rest home for two weeks'
respite care. Prior to this admission the patient was able to
mobilise short distances with a walking frame, but required full
assistance with all her cares.
Shortly after her admission the rest home experienced an
outbreak of Norovirus and went into "lock down". As a result,
infected residents were placed into isolation. Additional bureau
nurses were brought in to assist and were involved in nursing all
uninfected residents, including this elderly lady.
Throughout her admission the patient refused, or ate only small
amounts of many of her meals. She spent most days in either a
reclining chair or bed.
When the daughter arrived to pick her mother up she was shocked
by her appearance. She reported that her mother had lost a
considerable amount of weight and appeared very dehydrated. The day
following her discharge she lost consciousness at home and was
admitted to hospital. She died later that day.
It was held that the rest home was under a lot of pressure
managing the Norovirus outbreak. However, it did not have adequate
safety measures in place to ensure the patient received adequate
care and monitoring throughout her stay, and breached Right
It was also held that the nursing team leader failed to
implement adequate monitoring when the patient repeatedly refused
food and fluids. While this failure did not warrant a finding of a
breach of the Code, the team leader was reminded of the importance
of initiating closer monitoring and providing adequate clinical
While not the subject of this complaint, there was also a
concern that the rest home did not have a clear medication
administration policy and a review of this was recommended. Comment
was made on the poor communication with the patient's daughter at
the time of discharge but it was noted that steps were taken to
address this issue.