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Provision of care to patient requiring ambulance transfer (13HDC01568)
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Accident and emergency clinic ~ Registered nurse ~ Vomiting
blood ~ Assessment ~ Monitoring ~ Failure to call ambulance ~ Right
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.