Patient Care/Care of the Elderly
A medical negligence claim can arise out of the management of a patient’s care or rather a failure to properly manage a patient’s needs (or a nursing home resident’s needs).
Care of the Elderly raises particular issues – An elderly patient (or nursing Home resident) may not be in a position to properly articulate their needs or concerns. They are a potentially vulnerable section of society.
Examples of patient care/management:
Failure to keep proper records - Medication could be given twice or not at all if medication sheets are not properly completed. Patients can be discharged without proper information if information is missing from the records.
Failure to properly administer medication – The medication prescribed may not have actually been given to the patient/or the patient could have been given the wrong dose.
Failure to properly operate machinery – If the machine is not set correctly it will not function as intended.
Failure to refer to a specialist - For example, failure to involve a tissue viability nurse, or an orthopaedic consultant.
Failure to risk assess or properly risk assess - For example failure to identify a risk of falls, a risk of pressure sores, nutritional needs (food and drink).
Failure to manage/monitor – having identified a potential risk, that potential risk needs to be monitored eg fluid charts to monitor the amount of fluid a patient is getting, nutrition charts to record what the patient is eating (and of course in the case of food and drink – it needs to be either given to the patient or left within reach of the patient, it is self evident that it should not be out of reach), a pressure sort chart to grade pressure sores, a call bell (and again it is self evident it must be within the patient’s reach).
Failings in any the above may raise questions as to the adequacy of the care a patient is receiving and may amount to a breach of the duty of care owed to the patient.
Care should be given by a person properly qualified, trained, supervised and in a position to give that care (ie not being overworked/overstretched).
This includes proper communication between those involved in the care, (usually by oral handovers or written records). It includes the use of the correct equipment by staff trained to use that equipment. And it includes having the right number of staff for the care needed.
For example, an understanding of nutritional and hydration needs. Is the elderly person getting enough fluids? How do you know? Are fluid charts being maintained?
Is the elderly person getting enough nutrition and is right for their needs? Are they being given food they are able to eat and are willing to eat? If food is left with an elderly person in a communal area, how do you know who ate the food.
Has the staff had manual handling training? If the staff are not properly trained then they may not know, for example, how to lift an elderly person properly. A failure to lift properly can cause injury.
Is the elderly person at risk of developing bedsores? Bedsores are a common problem with elderly immobile residents and they need the right mattress and ‘turning regimes’ to minimise the risk. You would expect a tissue viability nurse to be called in when bedsores develop.
Are signs of infection being monitored? Is there a procedure for vetting and managing the risk of C. Difficile and/or MRSA?
Are toilet needs being met? Are incontinent aids being properly used, are the elderly residents being toileted properly and regularly.
The care of the elderly is not easy, particular when dealing with for example dementia sufferers.
The Care Quality Commission has raised concerns about the care of the elderly in NHS Trust and has highlighted particular Trusts. Their concerns include basic needs such as enough food and drink and being cared for in a dignified way.
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