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Wound management at aged care facility (12HDC01229)

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(12HDC01229, 26 September 2014)

Aged Care Facility ~ Respite ~ Standard of care ~ Wound care ~ Care planning ~ Assessment and monitoring ~ Rights 4(1), 4(2), 4(5)

A 70-year-old man was admitted to an aged care facility for 18 days of respite care. The facility specialised in providing hospital and dementia care. The man had multiple co-morbidities, including type II diabetes. His left leg had been amputated below the knee, and his right foot had two chronic infective ulceration wounds on his big toe and heel. These wounds had been managed in the community by district nurses for several years. In addition to the two ulceration wounds, the man had a skin tear on his right leg.

During his stay, the man's right foot wounds deteriorated, particularly his right big toe, which became necrotic. In addition, it was suspected that he had a urinary tract infection. The man was prescribed antibiotics by his general practitioner (GP). Despite evidence of necrosis, the nursing staff at the facility did not request that the man's GP review him in person, nor did they inform his GP of the deterioration of his wounds.

Two days following his discharge from the aged care facility, the man was admitted to a public hospital, presenting with gangrene of his right big toe. His right leg was subsequently amputated above the knee.

It was held that the aged care facility did not provide services with reasonable care and skill with regard to assessment on admission, care planning and wound care. There was a lack of adequate assessment and follow-up of a change in health status. The aged care facility breached Right 4(1).

The man had a right to have services provided that complied with legal, professional, ethical, and other standards. The aged care facility's documentation and communication with the man's family did not meet the NZ Health and Disability Sector Standards and breached Right 4(2).

The aged care facility's staff failed to communicate effectively with one another and with the GP to ensure that the man received continuity of services. This was a breach of the man's right to have co-operation among providers and to ensure quality and continuity of services. Accordingly, the aged care facility breached Right 4(5).

Adverse comment was made about the aged care facility's use of wound care products, and about the GP's documentation.

The aged care facility was referred to the Director of Proceedings. The Director filed a claim at the Human Rights Review Tribunal which proceeded by agreement. The Human Rights Review Tribunal made a declaration that the providers had breached Right 4(1) of the Code.

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