[ad_1]
Deputy Health and Disability Commissioner Deborah James
has found Te Whatu Ora – Te Pae Hauora o Ruahine o Tararua
MidCentral (formerly MidCentral DHB) breached the Code of
Health and Disability Services Consumers Rights, for failing
to ensure a woman had enough information to give informed
consent to the off-label use of a sedative medication
(droperidol). The woman experienced an adverse reaction
after droperidol was administered.
The woman visited
her ED with pain her leg during a very busy time. Without
being reviewed by a medical practitioner, she was
administered an off-label sedative (droperidol) for pain
relief by a registered nurse.
Droperidol is approved
for use as a sedative in New Zealand, and use as pain relief
is considered “off-label”. It is recommended that patients
are monitored carefully after its administration, but no
such monitoring occurred.
The woman stated that if she
had been told the drug was a sedative, she would not have
given consent as she is a busy mum and knows sedatives make
people sleepy and she never would have been “ok with
this”.
As the prescribing doctor could not be
identified, Ms James considered the DHB was responsible for
failing to ensure the woman was provided sufficient
information about droperidol and its off-label
use.
“Mrs A should have been told what was being
prescribed (droperidol), the primary use of that medication
(as a sedative), its primary side effects, why it was being
prescribed for her (to relieve her pain), and that such a
use was not an approved use of the medication. This was
information that a reasonable consumer in Mrs A’s
circumstances would expect to receive, and needed to receive
to give informed consent.”
Ms James was also critical
that staff failed to monitor the woman after droperidol was
administered.
“Despite a clear expectation that the
woman should have been monitored after droperidol was
administered, there is no evidence that the prescriber gave
any instructions for monitoring, or that any staff member
thought to observe her regardless of any instructions, which
meant that her adverse reaction went
un-noticed.”
Deborah James made a number of
recommendations including that the DHB provide a written
apology to the woman; provide HDC with an audit of ED
medication charts over the past six months to check the
compliance of doctors entering Medical Council of New
Zealand registration numbers on the medication chart; and
provide HDC with an updated plan for improving waiting times
in the ED.
MidCentral DHB has since devised a
medication charting guideline for patients waiting to be
seen in ED, and a list of medications allowed to be given to
patients waiting to be seen. This includes which medications
can be given by registered medical officers and which areas
of ED are appropriate for the administration of specific
medications.
ENDS
Editors notes
The full
report of this case (20HDC00962) will be available on
HDC’s website.
Names have been removed from the report to protect privacy
of the individuals involved in this case.
The
Commissioner will usually name providers and public
hospitals found in breach of the Code, unless it would not
be in the public interest, or would unfairly compromise the
privacy interests of an individual provider or a
consumer.
More information for the media and HDC’s
naming policy can be found on our website here.
HDC
promotes and protects the rights of people using health and
disability services as set out in the Code
of Health and Disability Services Consumers’ Rights (the
Code).
Communications team, Health and Disability
Commissioner
© Scoop Media
[ad_2]
Source link