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Standard of care in a rest home (09HDC02110)
Download Standard of care in a rest home (09HDC02110) (PDF 40Kb)
(09HDC02110, 2 March 2012)
Rest home ~ Registered nurse ~ General manager ~ Clinical
co-ordinator ~ Caregiver ~ Constipation ~ Standard of care ~
Supervision of staff ~ Clinical governance and quality systems ~
An elderly resident in a rest home became unwell with abdominal
pain one morning. A caregiver reported the man's condition to the
clinical coordinator, a registered nurse. The clinical co-ordinator
instructed the caregiver to telephone the doctor and ask the doctor
to visit the man.
The caregiver advised the doctor that the man had not had a
bowel motion for three days. The doctor instructed the caregiver to
assess the man's vital signs and then report back. The caregiver
had difficulty assessing the man's blood pressure and pulse and
advised the clinical coordinator of his concerns.
The clinical co-ordinator assessed the man, reported her
assessment of the man's vital signs to the doctor and made an
appointment for the man to be seen at the doctor's practice later
that afternoon. The clinical coordinator then left to attend a
The man was escorted to the doctor's surgery. The doctor
performed an urgent examination of the man's abdomen and diagnosed
that he was seriously unwell. The man collapsed and died before an
ambulance could be called.
It was held that the clinical co-ordinator was responsible for
the overall management of patient care and therefore was expected
to provide care at the level of a registered nurse. On the day the
events occurred, the clinical coordinator did not undertake an
adequate assessment of the man's condition, and failed to give the
caregiver sufficient instructions for the man's care before leaving
for her meeting. Accordingly, she breached Right 4(1).
The general manager of the rest home was not directly involved
in the care of the man at the time. Nor was she advised by any
staff member that there were concerns about the man's condition. In
the circumstances, it was reasonable for the general manager to
assume that the clinical co-ordinator would provide an appropriate
standard of care to all residents. Accordingly, the general manager
did not breach the Code.
The clinical co-ordinator and the general manager considered
themselves to be overworked and not sufficiently supported to
perform their duties adequately. While the rest home had a
responsibility to have appropriate structures in place, it was held
that there was insufficient evidence to establish that any
inadequacies on the part of the rest home were sufficient to impact
on the clinical co-ordinator's ability to properly assess the man
and provide him with an appropriate standard of care. Therefore the
rest home was not found in breach of the Code.