Bandaging on elderly woman caused unacceptable harm and distress

The importance of applying a patient-centred approach to care, and involving family members when warranted was highlighted in a decision published by Deputy Commissioner, Rose Wall.

In her decision, Ms Wall found a Clinical Nurse Manager in breach of the Code of Disability Services Consumers’ Rights (the Code), for failing to provide services that minimised potential harm to an elderly woman, and for not optimising her quality of life.

This case involves an elderly woman who had recently suffered a stroke and was confused and unsettled. She was separated from family, being cared for in a busy hospital environment by people she was unfamiliar with.

"Given her vulnerabilities, the onus was on the health professionals involved in this woman’s care to ensure any intervention was carried out with respect, with reasonable care and skill, and with due consideration to her dignity," said Ms Wall.

"The actions of the Clinical Nurse Manager and the manner in which she bandaged this elderly woman’s hands and arms to stop her from moving them was unacceptable. The use of this kind of restraint, and the way in which it was implemented, clearly does not align with current best practice," said Ms Wall.

During the woman’s stay in the neurology ward, the Clinical Nurse Manager applied bandaging to her hands and arms, to stop the woman from hurting herself. Unfortunately the Clinical Nurse Manager overlooked the risks and harm that could be caused, and failed to exercise reasonable care and skill in the bandaging process. The way in which the woman’s hands were restrained caused bruising and discolouration to her hands, and also resulted in her right thumb being found in an abnormal position.

After the bandaging was applied, the Clinical Nurse Manager failed to monitor or review the woman, or organise someone else to monitor and review her. This meant the woman suffered unnecessarily over an extended period. The Clinical Nurse Manager also did not document the care provided. Other nursing staff did not monitor the woman, and the harm was not identified until the following morning.

The Clinical Nurse Manager also did not communicate with the woman’s family in order to de-escalate her unsettled behaviour.

"Communication with the woman’s family should have occurred to facilitate the provision of health services that respected her social needs, values, and beliefs," said Ms Wall.

Ms Wall noted that while the DHB has a duty of care to patients, and a responsibility to keep them safe whilst in hospital, she did not find them to be in breach of the Code.

She made educative comments about a proactive strategy for behaviour of concern, and the ability of junior staff to raise concerns about care provided by senior staff.

Ms Wall recommended the Clinical Nurse Manager provide a written apology to the woman’s family, and provide evidence of having completed training on the use of restraints and the management of actual or potential aggression.

She also recommended the DHB provide an apology to the woman’s family and provide evidence that changes made and training provided to nursing staff have been effective, and consider implementation of the recommendations made by HDC’s independent nursing advisor.

Following the events, the DHB conducted an internal review with the nursing staff involved, and as a result of this complaint, it has implemented a number of changes to its processes and procedures and ensured its staff undergo further training. The Clinical Nurse Manager has undergone further training and implemented changes to her practice.

"Complaints offer a significant learning opportunity, to reflect on how care could be improved. I am pleased to see the nurse has made changes to her practice and undergone further training," said Ms Wall.