Facility ‘failed to escalate condition’

THE Aged Care Complaints Commissioner found Yallambee Aged Care “failed to adequately document” Steve’s clinical notes “or escalate his condition to a doctor when he was unwell between January 5 and 8, 2018”.

In a report finalised on July 25, a delegate of the ACCC said Steve’s care records showed he was transferred to hospital early on January 4, and returned to the service at 9am the next day “where he was appropriately assessed and monitored by a registered nurse”.

Over the next three days, the report said Steve was again unwell at times.

“While the information supports that the service was regularly monitoring his condition and providing appropriate treatment of his symptoms, it did not escalate his condition to a doctor for review as is reasonable to expect,” the report said.

“For example on 5 and 6 January 2018, Steve’s oxygen saturation was at times low, and was accompanied by a very high temperature, sweating and low blood glucose levels.

“There is no information to indicate the service contacted a doctor.”

The ACCC found that when Steve’s condition rapidly deteriorated over January 9 and 10, Yallambee acted appropriately in transferring him to hospital and notifying his doctor.

“In addition to the above concerns regarding escalation, a review of (Steve’s) clinical notes reflects that on multiple occasions a nurse made late entries into the system, limiting the ability to ensure his continuity of care and robust clinical assessment,” the report said.

“As a result of the complaint the service has implemented a range of quality improvements including a review of policies and procedures, provision of training to staff, and system enhancements.

“I am satisfied these actions address the service’s failure to provide clinical care of a required standard as identified through this complaint.”