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A Report by the Ombudsman in relation to a complaint about the care and treatment of a patient at St Mary's Care Centre, Mulingar, Co Westmeath

Chapter 7 - Recommendations

Recommendations:

Notwithstanding the recommendations by the Review Group which have already been implemented following examination of this complaint, I wish to make a number of recommendations of my own.

I recommend that St Mary's Care Centre, in conjunction with the Health Service Executive - Dublin Mid-Leinster:

• Develop written protocols with regard to the referral of patients (both respite and long-stay patients) for all para-medical services, including speech and language therapy assessments. These protocols should be understood and implemented by all members of staff, including medical staff, and new or temporary staff in the Centre, and should provide for urgent referrals when regular para-medical staff members are unavailable;
• Provide ongoing education and training programmes for all staff members to ensure that they communicate effectively with each other, with the elderly residents, and their families;
• Revise and develop protocols for the admission of a person for respite care, particularly if it is a first respite admission, to ensure that all of the patient's needs are identified, and provided for in a timely manner. Consideration might be also be given to meeting with the patient's carer/s in advance, and having the patient examined by the Medical Officer on day of admission;
• Revise protocols for nursing staff to reflect best practice with regard to the turning of patients who are susceptible to developing pressure sores;
• Develop protocols for nursing staff with regard to the seeking of advice from the Director of Nursing on crisis intervention, and develop a policy regarding the transfer of residents to acute hospital services;
• Provide education and training for all nursing staff in caring for residents who may be unable to communicate their own needs;
• Arrange for Nursing staff to ensure that the wishes of residents and their relatives are documented, listened to and acted upon, and that carers/relatives are kept fully informed with regard to their relatives' condition. If any difficulties arise with regard to the management of any patient, their principal carer or next of kin should be immediately advised;
• Record difficulties with regard to the administration of medication to patients in the nursing records and on the prescription sheet, and these records should accurately reflect the amount of medication administered and consumed;
• Review its procedures to ensure that all significant observations on a patient's condition are recorded in the nursing records, and that entries accurately reflect the interaction between nurse and patient, and include important interactions with his/her carer or relative;
• The General Manager should review the complaints handling process to ensure that complainants are kept fully informed and updated as to the status of their complaint, and to ensure that there is a system in place which will ensure proper engagement between a complainant and HSE staff.

I also recommend that the HSE:-

• Should explore with the relevant stakeholders the possibility of introducing guidelines for Medical Officers with regard to the supply of medication for patients who are leaving hospital or nursing home care, to ensure continuity of care until they can arrange to be seen by their own GP;
• That the HSE - Dublin Mid-Leinster makes a "Time and Trouble" payment of €3000 to Mrs Moore in recognition of the effort expended by her in the pursuit of her complaint.

Emily O'Reilly

Ombudsman

July, 2008

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