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End-of-life care provided to rest home resident (13HDC00196)
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Rest home ~ End of life ~ Care planning ~ Pain management ~
An 83-year-old man was admitted to a facility for rest home
level care. He had a diagnosis of prostate cancer, as well as other
co-morbidities, but was mobile, relatively independent, and
prescribed pain relief medication only on an as-needed basis.
Three months later the man's condition deteriorated. The rest
home's general practitioner prescribed the man regular pain relief
medication and, two days later, end-of-life care was commenced for
the man. Standing orders, which allowed for the man to have more
medication to keep him comfortable, were commenced the next day.
The Liverpool Care Pathway was commenced two days later. The man
died in the early hours of the following day.
Although there was some care planning for the man on his
admission, no update was made to his care plan when his condition
changed. The man's progress notes record that, while he was
receiving end-of-life care, on a number of occasions he was in
pain. The documentation shows that, rather than being
actively and consistently assessed, monitored, and documented, pain
management was provided in an ad hoc manner. These deficiencies in
care stemmed from a lack of understanding amongst staff about the
importance of care planning and pain management in the context of
It was held that the standard of care provided to the man fell
below an appropriate standard. The lack of appropriate care
planning, inadequate pain management, and the general lack of
understanding amongst staff about end-of-life care amounted to a
failure to provide services with reasonable care and skill.
Responsibility for that failure lay with the rest home.
Accordingly, the rest home breached Right 4(1) of the Code.
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