BACKGROUND
This case pertains to a real-life incident that was reported to the Health and Disability Commissioner in 2017.
The complaint is filed against Bupa Care Services NZ limited by the family members of Mr A, who was admitted to Bupa’s care home facility and unfortunately died due to negligence and carelessness of care-home staff. This case looks at the events in detail that led to this unfortunate incidence and tries to understand what each staff member associated with this case directly was supposed to do and where did they falter in performing their duties effectively. In specific, the case study aims at looking at the following questions:
1. Identify as many policies and regulations that were breached in this case?
2. What did the Clinical Manager fail to ensure and what effect did that have on the outcome of the incident?
3. Role of the registered nurses and what breaches of the NCNZ Code of Conduct for nurses took place?
4. What was the role of the Facility Manager in this case and what they could have done to ensure that this outcome is not repeated?
As we can see that this case brings on a very critical question to the mainstage. What are the implications and results when people who are entrusted to save lives fail in performing their duties properly. In this case, not only a human life is lost but the devastating effects on the family are long lasting.
APPROACH
We will look at each question separately and try to arrive at the reasons that led to this instance by taking each question one by one.
POLICIES & PROCEDURES BREACHED
ϖ Bupa
o Failed to administer pain assessments effectively
o Failed to undertake medical management
o Failed to do correct documentation
o Failed to adhere to NZ 8134 health and disability services Standards
o Failed to communicate with relatives on time
o Failed to follow policy and procedures as per core standards and requirements
ϖ Registered Nurse
o Failed to administer requisite pain assessments
o They failed to undertake steps for following policies and procedures
o Did not follow requisite documentation procedures
o Failed to communicate with relatives in timely manner
o Failed to undertake medicine administration
o Failed to adhere to consumer code
o Failed to demonstrate leadership
ϖ Clinical Manager
o Clinical manager failed to be an effective leader under the circumstances
o Was not effective in upholding policies and regulations for self as well as team
o Failure in following up on medication errors
o Failure to come up with a corrective action plan in time
o Totally failed in ensuring that pain relief was given on time
o Failed in having desired communication with other staff members
o Failed in maintaining the desired Consumer Code
ϖ Facility Manager
o Failed to be aware of what’s happening around and communicate accordingly
o Failed to identify gaps and take corrective actions
o Failed to communicate with patient’s family in time
o Failed to lead by example and show leadership skills
FAILURE OF CLINICAL MANAGER
Clinical manager’s is a critical position in care homes and this case is a live example of what can go wrong if the clinical manager fails to do justice to their roles and responsibilities.
According to (Whyte, Class Lecture, 2017) clinical manager has a specific job description and they are required to adhere to the same for effectively managing the facility to uphold the quality standards of the care home. These responsibilities are enlisted below:
1. Ensure optimum resident occupant numbers by interacting with social bodies and promoting the organisation to ensure financial viability
2. Diligent planning and effective implementation of directives to ensure ongoing care. This has to be done in conjunction with directives and contractual obligations of DHD, Ministry of health and the care home organisation
3. Ensuring an efficient and effective nursing practice while maintaining the safety standards
a. Ensuring equal treatment of every client in accordance with the Treaty of Waitangi
b. Oversee and direct day to day care giving activities
c. Communicate and respond to client’s family members in regards to medical intervention of client needs
d. Record maintenance and other administrative duties fulfilment
e. Ensure harmonious environment
4. Ensuring and maintaining a very high degree of standard in housekeeping services to assure client satisfaction
5. Review & implement resident therapy system
6. Ensure safe environment for residents, visitors and staff
7. Ensure all medications are administered in safe way
8. Requisite staffing levels are maintained and continual learning and development of staff
9. High level delivery of administrative duties
10. Establish and implement effective QA program as being the quality manager
11. Attending inspections from appropriate health and safety authorities and to instigate required changes
12. Available on call as needed
13. Knowledgeable of administrative process, policies and protocols
14. Willing to take up additional responsibilities that involves care home resident’s welfare as and when required by directors
15. Responsible for Open Disclosure
16. Responsible for relevant notifications to all concerned parties
17. Ongoing learning and training development
From the list of duties that a clinical manager is supposed to perform, I have marked in red the ones that were not performed properly, which resulted in the sad incident in this case that led to the loss of a human life (Whyte, Clinical Manager pdf, 2017)
ROLE AND BREACH OF NCNZ CODE OF CONDUCT FOR NURSES
Following breached are observed in the NCNZ code of conduct: (Whyte, 2017)
1. Principle 1: Respect the dignity and individuality of health consumers
¬ 1.1, 1.3, 1.4 & 1.10
2. Principle 3: Work in partnership with health consumers to promote and protect their well being
¬ 3.1, 3.2 & 3.5
3. Principle 4: Maintain health consumer trust by providing safe and competent care
¬ 4.1, 4.3, 4.5 4.8 & 4.9
4. Principle 6: Work respectfully with colleagues to best meet health consumer needs
¬ 6.2, 6.3 & 6.6
5. Principle 7: Act with integrity to justify health consumers’ trust
¬ 7.3 & 7.4
6. Principle 8: Maintain public trust and confidence in nursing profession
¬ 8.4
ROLE OF THE FACILITY MANAGER AND WHAT COULD HAVE BEEN DONE TO AVOID THIS?
Facility manager or Care home manager has a pivotal role in managing the facility. They are at the helm of affairs and are responsible to effectively manage the operations and represent the company. They are responsible that every resident receives optimal care and support. They are responsible to coordinate and lead other staff of the care home. They are responsible to work directly with the resident and their relatives to ensure resident’s well-being. While they have a large list of key responsibilities according to the JD (Whyte, Class Lecture, 2017), we will look at the one’s that were not performed properly and led to the incident:
¬ Ensuring optimal care and support to every resident
¬ Effective liaison and consultation between staff, resident and their family members
¬ Staff skill quality and training
¬ Effective staff communication and coordination
¬ Demonstrate sound understanding and implementation of policies & Procedures
¬ Fulfilling role of privacy officer
References
Whyte, J. (2017, October 21). Class Lecture. MHRE Lecture. Auckland, Auckland, NewZealand: n.a.
Whyte, J. (2017, October 29). Clinical Manager pdf. Retrieved from https://moodl
e.ais.ac.nz: https://moodle.ais.ac.nz/mod/folder/view.php?id=43018
Whyte, J. (2017, October 28). MHRE Readings. Retrieved from https://moodle.ais.ac.nz: https://moodle.ais.ac.nz/mod/folder/view.php?id=43018