Nurse's competence questioned after patient fall

A nurse's competence has been questioned after inadequate care was given to a patient who had a fall. Photo/123rf

A registered nurse's fitness to practice has been questioned after he failed to provide adequate care to a brain injury patient who hit his head in a fall.

The man who had suffered a brain injury was transferred to a residential care facility for dementia and psychogeriatric residents run by Bupa.

The man fell and hit his head a few days after being moved into the facility.

A healthcare assistant who observed the fall informed a registered nurse but did not record it in the progress notes, and did not complete an incident form until the following day.

The nurse did not request a referral of the man to another health professional or the hospital. In addition, the nurse did not notify the man's family of the incident, or hand over information about the fall to the registered nurse on duty that night.

The nurse did not make any record of the fall until the next day when she made a retrospective entry in the progress notes that there was grazing on the man's forehead, that he had been resistive and agitated, that observations could not be done, and that he had been placed on the list for a post-fall doctor's review.

The following day, another registered nurse noticed bruising of the man's left eye, but did not record the injury or any assessments having been performed. The man's wife visited, and was distressed to find her husband lying in bed, injured and unkempt.

Over the next few days, the man's condition deteriorated and he became more aggressive and resistant to care. The man was moved back to a public hospital because staff at the facility felt that it was unsafe to look after him.

Deputy Health and Disability Commissioner Rose Wall said care planning was inadequate, prompt action was not taken when the man's behaviour deteriorated, the management and follow-up of the man's fall was poor and the oversight of the healthcare assistant was inadequate.

She recommended the Nursing Council consider whether a competence review of the nurse was warranted should he return to nursing in New Zealand. She was critical of his inadequate oversight of the healthcare assistant, poor response to the man's fall, and inadequate record-keeping.

Wall was also critical of the healthcare assistant for not recording the fall in the progress notes, not alerting the nurse on duty to the man's change in condition, and not providing appropriate care to the man.

Wall recommended the company audit the changes made to policy and procedure to determine how effective they were and said the company, nurse and health care assistant should all apologise to the man's wife.