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CASE STUDY 3 Inquest into the death of a 75-year-old woman who died from sepsis arising from contaminated pressure sores. Background She had fractured her hip a few years before her death, and due to her fear of having another fall, spent much of each day seated on a chair. She had trouble with slowly healing leg ulcers, and pressure sores on her heels, thighs and buttocks. She had type 2 diabetes, requiring insulin, and congestive cardiac failure (CHF), both of which contributed to the slow healing of wounds. During a three-week admission to the hospital, her pressure sores were reviewed and gradually improved. The deceased was provided with a specialised pressure area care cushion and advised about pressure relief for the affected areas; however, she did not use the cushion when she returned home. An Aged Care Assessment Team (ACAT) recommended that she would best be looked after in residential care, but the deceased and her family declined this, preferring to look after her in the family home where she lived with her son. Her daughters lived nearby and helped with meals and housework. The highest-level home care package was approved, allowing for personal carers and a nurse to visit three times a week to assist with showering and wound dressings. The deceased managed her own medication doses, with family assistance, and insisted on managing her own dentures. She was incontinent of urine and faeces and told her family that she was able to change her own incontinence pads without their involvement. At times she refused care of her pressure areas and ulcers. Incident Over the next ten months, she was visited at home by a regular team from a private home care service provider. The nurse visiting her home was often hindered by insufficient supplies of dressings from the home care service provider, as well as difficult documentation processes including a lack of integrated progress notes for each client, and no provision of wound assessment forms. Initially the deceased was relatively active; able to look after her own grooming and toileting, but gradually became less independent and mobile. Increased assistance with bathing was arranged, but the budget allocated in the home care package did not allow for daily dressings of her pressure sores. Two months before her death the deceased’s pressure sores deteriorated. She was seen at home by a locum General Practitioner (GP) when she developed a urinary tract infection (UTI), but she refused to get up from her chair to allow full examination. She was later seen at a local emergency department (ED) with back pain, though it is likely her sacral wounds were not seen by hospital staff. In the weeks before her death there was the breakdown of skin and some very deep sacral wounds. The visiting nurse raised her concerns over these with the deceased, her family, and her manager. The deceased did not change her habit of sitting on a chair for prolonged periods of time. HLTH7029_Assessment 1_CaseStudies 6 The deceased became quite unwell and after initially refusing to go to hospital, was taken to the ED. Concern was raised about her care at home as hospital staff noted the contaminated deep sacral pressure sores, and that her dentures were blackened and discoloured. She had developed sepsis and acute kidney failure. Despite antibiotics and medical management, she died a few days later. Inquest findings and comments. The coroner found that death was caused by organ failure due to sepsis from infected pressure sores, and by manner of natural causes. The coroner commented that the infection resulted from deterioration in her condition in circumstances where, due to choices she consciously made, the likelihood of life-threatening infection was significant. write abstract, synopsis, discussion, recommendation and conclusion of the given case study

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