Page Section: Centre Content Column
Care of elderly man following fall (13HDC00732)
Download Care of elderly man following fall (13HDC00732) (PDF 72Kb)
District health board ~ Public hospital ~ Nursing care ~
Assessment ~ Pain medication ~ Nutrition ~ Right 4(1)
The family of an 89-year-old man complained about the care he
received in a public hospital. He had a history of Type 2 diabetes
(treated with insulin), ischaemic heart disease, hypertension,
dyslipidaemia, psoriasis, and transurethral resection of the
prostate. Previously he had had a triple bypass.
One day, the man fell while out walking. He was taken to
hospital by ambulance. The man was found to have a hip fracture and
was reviewed by the medical and orthopaedic teams. Due to his poor
clinical condition, the plan was to address his medical issues
prior to operating on his hip.
Throughout the man's 15-day stay at the hospital, he spent time
in four different wards. He complained of hip pain frequently, and
was vomiting. The pain team reviewed the man several times
throughout his stay and made recommendations. A range of oral and
intravenous medications was given to alleviate his pain, minimise
his confusion and reduce his vomiting. However, often he refused
oral medications, and sometimes the intravenous line did not work
The man also frequently refused food and drink. He was given
fluids intravenously and subcutaneously. Speech language therapists
reviewed him but were unable to assess him because of his
drowsiness and inability to follow instructions. A referral to a
dietitian was made on day 14 of his admission.
The man had become confused since his fall, and was very
restless during his time in hospital. He was given a low bed, and
partway through his stay was transferred to a low stimulus area. A
suprapubic catheter was inserted in an attempt to reduce his
restlessness. At times the man had an observer in attendance.
Laboratory tests indicated a possible urinary tract infection,
which was treated with antibiotics. A CT scan of his head did not
show anything of concern.
On day 8, a decision was made to proceed to hip surgery.
Following some confusion between staff and the man's family as to
what time he would have the surgery, the man went into theatre the
following afternoon. The surgery was uneventful.
Early one morning a few days following surgery, the man's family
called the hospital and were told that he was resting. Later, at
8am a nurse found him cold and unresponsive, and, soon afterwards,
Critical thinking was lacking in relation to the evaluation of
the man's pain and the management of his oral care, fluids and
nutrition. It was held that the man's assessment and management
were suboptimal with regard to his pain, oral care, nutrition and
fluids. Overall, the DHB failed to provide services to the man with
reasonable care and skill and, accordingly, breached Right