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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:
- 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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