Case Study Patient - Background Mrs Betty White, an 85-year-old woman who was admitted with a chest infection and diagnosed with Left lower lobe pneumonia. Whilst in hospital she sustained a fracture...

Case Study

Patient - Background

Mrs Betty White, an 85-year-old woman who was admitted with a chest infection and diagnosed with Left lower lobe pneumonia. Whilst in hospital she sustained a fracture of the right neck of femur.
Medical History:

1. Hypertension.  2. Hypercholesterolaemia 3. Asthma/COPD 4. Osteoarthritis

Social situation:

Betty is a widow of 5 years and has been living in a low care aged care facility since her husband’s death. She participates in the social activities within the aged care facility. Betty has a supportive family (1 son and 1 daughter – her daughter lives locally and visits twice a week; her son lives interstate with his family).  Members of her church parish also visit her once a week.  She is a retired office worker. No longer drives – uses family and taxis to get around.  Betty is an ex-smoker who gave up smoking 10 years ago. Betty does not have an Advanced Care Plan in place, however her daughter Jane has medical power of attorney.

Reason for admission (10 days ago):

10 days ago, at 0200 hours Betty was brought in via ambulance to the Emergency Department (ED) following a period of high temperatures, shortness of breath and chest congestion.   Her daughter, Jane, was notified of her hospitalisation and came into the ED to sit with her mother. A chest x-ray and blood tests conducted in the ED revealed that Betty had pneumonia and she was commenced on intravenous (IV) antibiotics, oxygen therapy and Ventolin and Normal Saline nebulisers.  Later that afternoon Betty was transferred to the respiratory/medical ward.  She was accommodated in a 4-bed ward quite a distance away from the nurses’ station.


Her daughter Jane stayed with Betty throughout the shift.  She asked the nursing staff whether her mother had been given any of her usual morning medications because Betty could not remember having had them whilst in the ED.  Staff checked the medication chart and found that Betty’s usual medications had not been written up on her medication chart.  Staff paged Betty’s doctor to have her medications written up.  Jane left for home at 9 pm.  Before leaving Jane spoke with the nurse in charge of the shift and left her name and contact details.  She asked to be contacted immediately if there were any changes to her mother’s condition.  She told the staff that she was concerned that her mother was not ‘quite herself’.  She seemed to be ‘a bit confused’.  She also told staff that this was not a usual occurrence for her mother, as she was normally quite alert and orientated.


Overnight Betty became quite distressed and more confused, calling out for her daughter.  Nursing staff attended to her on one occasion and re-orientated her to the hospital and ward and then left to attend to other patients.  At 2 am, a fellow patient in Betty’s room rang the staff call bell and called out in a loud voice for help.  The nurse allocated to Betty answered the call and discovered Betty laying on the floor next to her bed.  Her IV was pulled out, blood was all over the floor.  Betty was moaning.  A brief assessment revealed that Betty had a laceration to her forehead and her right leg and foot looked like it was externally rotated.  Betty had also been incontinent of urine on the floor.


Betty was reviewed by the resident medical officer, who ordered an urgent head CT scan and  x-ray of Betty’s legs. Results from the CT Scan was NAD, however the x-ray revealed that Betty had sustained an intracapsular fracture of her right neck of femur.  Betty was scheduled for review by the orthopaedic team later that morning.


At 11 am, Betty’s daughter Jane came in to visit her mother.  She was distressed to find that her mother had sustained a fall overnight and that she had a laceration to her forehead and had fractured her hip.  She demanded to speak with the nurse in charge.  She was angry that she had not been contacted and informed that her mother’s condition had changed and that she had sustained a fall.  She said that she had told the staff that her mother was confused before she left for home last night and demanded to know why her feedback regarding her mother’s confused state, had not been listened to.  She angrily stated that she wished to speak with the Patient Advocate officer as she was going to put in a formal complaint.  The Nurse Unit Manager organised a meeting for Jane with the Patient Advocate.  She also organised for Jane to meet with Betty’s doctors to discuss Betty’s progression of care.


Progression of Care

Betty was reviewed by the orthopaedic team and it was decided to treat Betty’s condition conservatively until her chest infection had improved.  One-week later Betty had surgery for her fractured right neck of femur and a dynamic hip screw was inserted.  Betty was transferred to the orthopaedic ward post-surgery.  4 days post-surgery, it was noted by the nursing staff that Betty’s hip wound edges were not healing and there was a distinct odour coming from her wound.  A swab of the wound revealed that Betty’s wound had developed an infection.
 Please answer the following questions, using academic language and format. Introductions and conclusions are not required. There should be only one reference list with a minimum of 18 references, the majority from peer reviewed literature published within the past 5-6 years.


Questions:


1. Identify and discuss the clinical practice issues of concern in Betty’s care during her hospitalisation. (500 words)


2. Identify all National Health and Safety Standards that have been breached in Betty’s care and discuss how these standards have been breached. (500 words)


3. From the list of identified National Health and Safety Standards you have identified in question 2, choose two (2) standards, and discuss how those 2 standards could have been maintained by the healthcare staff in the delivery of care to Betty and her family during her hospitalisation. Use current literature to support your discussion. (1000 words)


4. Based on your 2 chosen standards, what recommendations would you make for changes to health care practice at the ward level? Support your recommendations with rationales supported by evidence-based literature.  (250 words)