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Medical

Dismal care at a DHB - Rights 4, 5, & 6

Communication with the family of a man with dementia

A dramatic reaction to a test lands a consumer in hospital

Change in dialysis regime

Keeping families informed

Persistent infection

 

 

 

 

Dismal care at a DHB - Rights 4, 5, & 6

Prior to his loss of consciousness and subsequent death, a consumer made remarks to his family about the poor standard of care he received, and the lack of information and explanations given. He said he had observed that staff did not routinely wash their hands prior to patient procedures. He became very distressed about how painful his intravenous luer was and that the antibiotics being administered through it were given far too quickly. His daughter had to point out to staff that the area around the luer had become swollen, red, and hot to the touch.

The family stated they found it difficult to gain the attention of nurses, and were told that the unit was regularly understaffed relative to the number of inpatients and the complexity of their needs.

They believed the hospital-acquired septicaemia from the infected luer and subsequent pneumonia contributed to the consumer's death and was due to the lack of proper hygiene practices. His wife was very angry about the "shabby" way her husband was treated and these feelings have had an impact on her well being and how she has handled his loss.

After discussing the options, the family chose to write to the provider outlining the issues and seeking a meeting to discuss their concerns. They requested the advocate be included in all communication and meetings with the DHB. In their letter to the DHB they said they wanted to discuss the following: recognition that system failures contributed to the consumer's death, inadequate staff numbers for a complex busy facility, procedures to ensure consumers are fully informed, best practice hygiene procedures and monitoring of luers, taking notice when consumers complain about pain and for nursing staff to receive training about the effect of administering fluid via a luer too quickly.

The family was pleased with how the meeting went. They felt it was very productive, informative and with open discussion that they found helpful. DHB staff present acknowledged the issues raised and assured the family that the observations by their father and members of the family would be taken seriously. They sought permission to use the whole scenario as a case study for staff, which was agreed to by the family. The family was also pleased to hear the hospital is now part of the World Health Organisation infection control initiative to improve hygiene practices.

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Communication with the family of a man with dementia

A resident of a rest home suffered a stroke, was admitted to the local hospital and transferred to the rehabilitation ward. His daughter complained to an advocate that although she held EPoA (Enduring Power of Attorney) for her father because he had dementia, she was not given any information on what was happening to her father. She received a phone call about a family meeting to discuss her father's discharge, but was not given the date or time of the meeting.

The issues she had, included:

  1. Poor communication from staff at the hospital
    2. Lack of information on what was happening with her father
    3. Lack of information and details for the 'family meeting' eg, no date/time/venue given.

    She wanted to achieve:
    1.   Improved communication with staff at the hospital.
    2.   Information on what was happening with her father
    3.   Information on what supports would be put in place when he was discharged from hospital.
    4.   The details for the family meeting.

Although the man's daughter had spoken to the staff at the hospital she was not given the information she needed. Although she had managed to successfully advocate for her father in the past, she had recently been unwell and has found it difficult to keep on top of everything. She was also responsible for her 52-year-old disabled sister who lived in a nearby disability home.

At the meeting, with the support of the advocate, the family expressed their concerns and asked questions about their father's discharge from the hospital back to the rest home, as well as the support for their father's continued rehabilitation after his stroke.

The team explained that their father would be discharged back to his usual rest home by non-urgent ambulance. Assurances were given that the hospital team would provide the rest home with all information necessary for the staff to provide him with a high level of care.

The NASC coordinator explained that the rest home agreed to have him back on a six-week trial to see if they could manage the level of care that he would require. There would be a review at this time to see if the level of support was sufficient. If not, NASC would carry out another needs assessment to see whether he required a higher level of care which would require a move to another facility.

The family were very happy with the outcome. They informed the advocate that they planned to meet with the rest home manager and the charge nurse when their father returned to the rest home to discuss a number of issues such as appropriate food, mobility support, adapted cutlery and other supports he needed.

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A dramatic reaction to a test lands a consumer in hospital

A man contacted an advocate after ending up in hospital for four days recovering from an attempt to carry out a test.  He was upset about this because he has a medical condition which prevents him from undergoing this particularly stressful test. Despite his concerns that it would be detrimental to his existing medical condition, he was persuaded to undergo the test, which was, however, not possible to complete.

After considering the options he decided to write his own letter to the provider. He wanted to tell his own story and with the assistance of the advocate he identified the questions he wanted answers to.

The provider responded to his concerns, providing a full explanation of why the test was necessary. The man was happy with the response to his letter and the matter was concluded.

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Change in dialysis regime

For four years I had been on dialysis for four years. I got there because I have arteriosclerosis (blocking of the arteries by plaque). The first, dramatic, intimations I had the disease was when I sustained a heart attack sixteen years ago. Blocked arteries do not, of course, unblock - indeed they get worse and there came a time when the arteries to my kidneys got bunged up, stopping the blood flow, thus rendering my kidneys ineffective. Hence dialysis.

All had been going well for those four years. Apart from the tie of having to go to the hospital three afternoons a week (I'm not a suitable case for home dialysis) I was doing well for a 74 year old. My particular pleasure was to walk for an hour by the sea every day - weather permitting.

Then, without warning or explanation, things changed. My dialysis requires the insertion of a needle into the arm (quite painless) to allow the blood to flow through the machine. I had been on a gauge 14 needle but it was changed to a narrower gauge 15. This meant that the four hours I was accustomed to being hooked up was not long enough to effect a good dialysis. I found myself puffing and getting sore legs when I was walking. I could have opted to be on the machine longer - but four hours is quite long enough!

I also needed extra iron from time to time and this was done once a fortnight, intravenously, while I was dialyzing. No problem. Then the consultant physician ordered this practice to be stopped (long term effect, I was later informed. Long term? When I was 74?).

My efforts through the hospital management to get my former, perfectly satisfactory to me, treatment regime explained to me and reinstated were unsuccessful. In desperation I sought the help of my local advocate.

I am glad to say that her efforts to assist me were successful and my former treatment was resumed. I am now feeling much better. And enjoying those seaside walks once more!

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Keeping families informed

An advocate was contacted by the wife of a man who had died in hospital. She and her family had been unaware of the seriousness of his condition and had not been advised of his diagnosis or treatment.

After discussing options with the advocate, the family wrote to the provider outlining their concerns. They received a written response, and decided they would like to meet with staff from the DHB with the advocate for support.

At the meeting the family raised their concerns and advised that in addition to the answers they sought, wanted the hospital to review their protocols in regard to keeping families informed. The DHB staff responded to the family's concerns and apologised for the lack of communication, which the family accepted.

The DHB staff also agreed to look at the protocols for communicating with families, bearing in mind the need to respect privacy, and if any changes were made, said they would inform the family. The family was happy with the outcome of the meeting.

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Persistent Infection

A middle-aged man had a very serious fall with various injuries. In the course of treatment at the hospital he picked up two serious infections in one foot, which meant that 18 months later he required a district nurse to dress the infected foot every second day. 

He had to give up his successful physical career as he couldn't put weight on the leg or wear a shoe. He became socially isolated as he felt he had to live alone for fear of spreading the infection.

He was determined to have the leg amputated due to the distress of the persistent infections.  This outcome was not supported by medical staff.  ACC was working with him and he was receiving psychological support but  he was very low in mood and desperate for the hospital to amputate. 

He contacted his local advocacy service and the advocate worked with him, ACC, his psychologist and staff at two hospitals to eventually secure the outcome he wanted. 

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