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Provision of care to patient requiring ambulance transfer (13HDC01568)

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(13HDC01568, 7 January 2015)

Accident and emergency clinic ~ Registered nurse ~ Vomiting blood ~ Assessment ~ Monitoring ~ Failure to call ambulance ~ Right 4(1)

A 72-year-old woman had spinal surgery without complications and was discharged two days later. Two days following discharge, at 8.00pm, while the woman was at home, she vomited a large amount of blood. The woman's daughter took the woman to an accident and emergency clinic, arriving between 8.00pm and 8.30pm.

The woman's daughter told the receptionist that her mother had recently undergone spinal surgery and was vomiting up blood. Having overheard the daughter, a registered nurse (RN) told the daughter to call an ambulance for her mother to be taken to hospital. The RN considered that the woman required hospital treatment, and that a personal call would achieve a priority response from the ambulance service, rather than if the clinic contacted the ambulance for her. The RN did not triage the woman, take a history, or undertake an initial assessment of her. The woman's daughter immediately telephoned 111 on her cell phone from inside the building. The woman waited for the ambulance with her daughter, while lying down in the back of her daughter's car in the car park.

At 8.42pm an ambulance arrived and the woman was taken to hospital, where she was diagnosed with multiple stomach ulcers.

It was held that the RN failed to assess the woman when she presented to the clinic, failed to contact the ambulance service, and failed to offer any assistance to the woman while she waited for the ambulance, including monitoring her. Accordingly, the RN failed to provide services to the woman with reasonable care and skill, in breach of Right 4(1).

Adverse comment was made with regard to the RN's subsequent inability to provide handover to the ambulance service.

It was held that the clinic took steps that were reasonably practicable to prevent acts or omissions such as the RN's in this event. The clinic was not directly or vicariously liable for the RN's breaches of the Code. 

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