Nurse criticised for not giving CPR

An elderly rest home resident who was choking on mashed potato died without the nurse responding to her attempting CPR, the Health and Disability Commission has found.

Deputy commissioner Rose Wall yesterday released a report finding the nurse had breached the 85-year-old’s right to reasonable care under the Code of Health and Disability Services.

The nurse was called to assist a caregiver when the 85-year-old woman was found choking in the rest home dining hall, the HDC said. The woman was unresponsive, with no signs of breathing or radial pulse.

The nurse told another nurse to call 111 and administered four hard back slaps. After that didn’t work she moved the woman out of the dining room and on to the floor, again checking for signs of life. She made no attempt to perform CPR while waiting for the ambulance.

Paramedics found mashed potato blocking the woman’s airway. The woman was pronounced dead.

Wall criticised the nurse for failing to start CPR urgently. She acknowledged the potato was unlikely to have been dislodged by chest compressions, but said starting CPR would still be considered reasonable care.

The HDC found the nurse should have moved the woman to the dining room floor rather than spend 15-30 seconds getting her to another room.

The nurse said she moved the woman because there was limited space and to improve access for ambulance staff.

The deputy commissioner recommended the nurse write an apology to the woman’s family for breaching the code, although she made it clear that the nurse following correct procedure would not be likely to have saved the woman’s life.

She also recommended the Nursing Council of New Zealand review the nurse’s emergency response competency. The rest home has since developed a choking policy.