With an ageing population, more and more of us are being looked after in residential care and nursing homes. But according to a 2012 report by the Care Quality Commission the healthcare needs of society’s most vulnerable group of people are being neglected.
There are over 350,000 elderly people living in 10,000 care homes in England. Every one of them will have particular health issues and will need access to medical and other support, such as mental health, continence and tissue health, physiotherapy, diet and nutrition services. Approximately 40% of care home residents suffer from dementia and the average lifespan from admission is only two years.
So this is a challenging environment, and the provision of services between private and state run care homes and the NHS can be patchy to say the least.
Care homes owe the same duty as a hospital, hotel or any other institution that looks after residents. But they have to do more to meet that duty because of the vulnerability of those they care for and their wide range of needs. If they fail in that duty then serious injury or even death can result.
The following particular issues need to be identified and assessed by all care homes:
Control of Infection
Elderly people in care and nursing homes are particularly vulnerable to infection, which carries with it a high risk of mortality. So the premises and especially the kitchens and bathrooms need to be scrupulously clean. There must be strict hygiene policies in place to deal with food production and infection control. Staff and residents are at risk from waste and blood that is inadequately disposed of, contaminated food and medical equipment, legionella from poorly maintained water and air conditioning systems, and inadequately controlled infection in an individual patient.
Sadly there is malpractice in some care homes and the suspicion is that it it more widespread than is acknowledged. Since the Winterbourne View abuse scandal in 2007 there have been a number of prosecutions and reports of abuse, where those employed to look after vulnerable residents have been guilty of neglect and sometimes physical assaults. If a resident is abused in this way then the care home will usually be liable for the actions of their employees. Evidence is key and care home records, witness testimony and video and photographic evidence may all play a part in uncovering the malpractice.
Elderly residents in care and residential homes can be frail and suffering from illness or disease, so it is no surprise for there to be accidental injuries from trips, slips, falls, and other incidents. Such incidents are very common amongst elderly people who are living at home. But there is a distinction between those accidents on the one hand and avoidable injuries on the other.
For instance, an elderly person at home is very likely to check the temperature of the bath water before getting into it at home. If the job of bathing a vulnerable resident or patient is the responsibility of the care home they should have assessed the risk of burns and scalds and made sure that there are proper safety precautions in place, namely thermostatic mixing valves on the taps and care workers trained to test the water before bathing a patient. There have been several reported cases of patients being seriously injured or even killed by being bathed in scalding hot bath water.
Transfers and equipment
Another common situation involving risk of avoidable injury involves transfers. If a resident or patient is unable to transfer independently, for instance from bed to chair, their needs must be assessed and a proper system put in place. This may be a protocol for two carers to assist or may involve the use of a board or hoist. If the patient is left to their own devices or if the assistance or equipment are inadequate then there is a high risk of injury, and that injury will be caused by a negligent failure on the part of the care home.
Equipment must be properly used and the care providers trained in its safe use. A tragic example of where this can go wrong is the case in September 2012 where an elderly woman was asphyxiated in her bed between her mattress and the incorrectly fitted safety rail. Safety rails are commonplace in care homes to prevent falls, but in this case the staff weren’t properly trained in their use. The care home owners were prosecuted by the HSE and fined £180,000.
Falls in the elderly can be devastating, causing fractures which can lead to impairment and even death. While medical conditions such as confusion or hypoglycaemia can predispose patients to falling, simple precautionary nursing measures can protect vulnerable people from coming to harm through falling. For example, regular monitoring, moving personal items so that they are within easy reach and providing nonslip socks.
Hospital Acquired Infections (HAIs)
HAIs are infections that are picked up while in hospital or in other health care settings such as nursing homes. The worst cases can lead directly to death. Straightforward good nursing practice can reduce the risk of HAIs running rampant and causing harm. Basic hand hygiene, good wound care, sterile techniques and proper cleaning of medical equipment all contribute to safer patient care.
Medication errors are a significant problem in the NHS. Around 237 million medication errors occur in the NHS in England every year. Of these, avoidable adverse drug reactions contribute to between 2,000 and 22,000 deaths annually. These errors cost the NHS at least £98.5 million each year, although this could be a gross underestimation. Pharmacists, doctors and other health care professionals are all responsible for a wide variety of medication errors.
Nurses are responsible for the majority of medication administrations in a clinical setting. There are lots of reasons why a nurse may cause a medication error: similar drugs names, poor labelling and distraction when giving out medication.
According to the National Diabetes Inpatient audit, ‘2 in every 5 people with diabetes on insulin experience an error related to the administration of the drug while in hospital’.edication errors by nurses can also occur in the community. A study of people who received palliative care at home was published in the Palliative Medicine Journal.1 It was found that of 1072 patient safety reports over a five-year period, 613 were related to medication error. Around two thirds of these incidents caused harm to patients and 129 suffered serious harm, which led to either hospital admission or early death.
Midwives are highly trained nurses who specialise in providing care to pregnant women and their families, throughout pregnancy and labour and for a time after the baby is born. Midwives are rightly proud of their skills and relative autonomy during clinical practice, but sometimes because of this, it takes some time to pick up when a rogue nurse is working.
Nursing Care Claims
Like other healthcare professionals, nurses do not go to work to cause harm to the people to whom they are providing care, be it in a birthing suite, a neo natal ward or on the phone to a 999 caller. However, errors do happen and sometimes these errors cause serious harm or even death. If you think that you or a loved one has been the victim of nursing care negligence, then you may be entitled to claim compensation. To find out more, please get in contact with Osbornes Law. We have a team of medical law specialists who will be able to advise you if you have a claim and will guide you through the process.
Our Promise to You
- We will review your potential claim by advising you on the NHS complaints procedure or other alternative procedure if your case does not relate to NHS care and treatment.
- We will not charge a fee for our time in reviewing your case.
- We can assist you with any issues that you may have regarding the complaints procedure or that you encounter in obtaining copies of your medical records.
- We will advise you of the course of action in respect of your case
Written by Stuart Kightley