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Monitoring, assessment and investigation of pain (14HDC00121)
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(14HDC00121, 24 June
District health board ~ Public hospital ~ Compartment
syndrome ~ Monitoring ~ Pain assessment ~ Rights 4(1),
A 29-year-old man was admitted to a public hospital following an
accident in which he sustained a midshaft fracture of his right
tibia and fibula. The following day he underwent surgical
intramedullary (IM) nailing of his right tibia, and his leg was
placed in a plaster cast.
In the days following surgery it became apparent that his pain
was not being managed, and increasing levels of narcotic analgesia
were required. The man's postoperative course was of gradually
increasing pain with increasing analgesic demands, restlessness,
and urine retention. However, the cause of his increasing pain and
distress was not identified until the third day following surgery
when a diagnosis of compartment syndrome was made.
It was held that the man's pain assessment and monitoring, most
notably by the registered nurses responsible for his care, was
below accepted standards. The man was not provided with services in
a manner consistent with his needs and, accordingly, the DHB
breached Right 4(3).
It was also held that there were insufficient efforts by the
orthopaedics team to investigate the cause of the man's pain. This
failure led to a delay in diagnosing his compartment syndrome. It
was found that the DHB was responsible for this failure by multiple
staff. Accordingly, the DHB failed to provide services to the man
with reasonable care and skill and breached Right 4(1).
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