Nurses failed to manage patient's pain, says Health and Disability Commissioner

Health and Disability Commissioner Anthony Hill says in a report released today that in the days following surgery it became apparent the man's pain was not being managed Photo / iStock

A district health board's nurses have been instructed to ask surgical ward patients every hour if they have any pain or need any other basic nursing care.

This comes as a result of failings in the care of a man who had suffered a fractured lower right leg and escalating pain and distress.

The man, aged 29 at the time, was admitted to a public hospital on New Year's Eve in 2013 following an accident.

Health and Disability Commissioner Anthony Hill says in a report released today that in the days following surgery it became apparent the man's pain was not being managed; increasing levels of narcotic analgesia were required.

He experienced increasing pain, analgesic demands, restlessness and urine retention. The cause of the increasing pain and distress was not identified until January 4, 2014, when a diagnosis of "compartment syndrome" was made.

This condition results from swelling or bleeding within a part of the leg and can lead to dangerously high pressure and damage to nerves and muscles.

The man's pain assessment and management, mainly by nurses, was below accepted standards, Mr Hill said.

He also found there were insufficient efforts by the orthopaedics team to investigate the cause of the man's pain before January 4. This failure led to a delay in diagnosing compartment syndrome.

The Southern DHB breached the code of patients' rights on two counts: failing to provide services with reasonable care and skill; and not providing services consistent with the man's needs.

Mr Hill said that although the DHB had made "suitable changes following these events", he was critical that such measures were not in place at the time.

He said the DHB told him that as a result of its investigations into the man's care, changes it instituted included that hourly rounds of surgical wards were now conducted by registered nurses. This helped to quickly identify patient's emerging issues.

On these rounds, the nurses tell patients "I have the time to help you" and ask specific questions:
• Do you have any pain?
• Do you need to go to the toilet?
• Do you need repositioning?
• Is there anything else you need?