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Postoperative care of patient with special needs (06HDC19538)

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(06HDC19538, 12 March 2008)

Public hospital ~ District health board ~ Breast cancer ~ Surgery ~ Post-anaesthetic care ~ Blood-pressure monitoring ~ High dependency unit bed ~ Staffing ~ Communication ~ Rights 4(1), 4(2), 4(5)

A man complained about the care his 55-year-old wife received following a routine operation in a public hospital. It had been agreed between the woman and her surgeon prior to surgery that she would have her operation in the local public hospital rather than a private hospital, because she required a high dependency unit (HDU) bed because of significant co-morbidities.

Unfortunately, when the operation was completed and the woman was in recovery, it was found that no HDU bed had been booked, as the system for arranging this had broken down. In addition, a bed was not available in the appropriate surgical ward, and she was transferred from theatre to a busy orthopaedic ward without the knowledge of the surgeon.

Once transferred to the ward, despite knowing that the woman would require the use of a larger bed, this had not been arranged and, with some difficulty, the nursing staff attempted to provide her postoperative care. The woman's postoperative care was jeopardised on the ward as monitoring equipment was unsuitable for the task or was not functioning, and the ward was inadequately staffed for providing the woman with appropriate care, given her special needs.

Unfortunately, the woman died the evening after surgery. When called to the ward after her death, and in the stages afterwards, the woman's family was not treated appropriately, and this caused them further distress.

It was held that the woman did not receive postoperative care of an appropriate standard, and clinical staff did not properly co-ordinate their care. In these circumstances, the district health board breached Rights 4(1), 4(2) and 4(5).

It was noted that the poor communication with the family after her death was naturally very distressing to them. It showed a lack of compassion and a disregard of the duty that hospital staff owe to the family of a recently deceased patient. At a time when accurate and sympathetic responses would have been of the greatest importance, the family did not receive the help they needed.