practice partner
Patient Safety
We use this forum to regularly report on findings from patient safety organizations, expert review committees
of the Office of the Chief Coroner, and inquests.
Assessment
needed for rapid
weight loss in
elderly patients
photo: istockphoto.com
photo: istockphoto.com
P
hysicians who note a rapid weight loss
in an elderly patient should thoroughly assess and evaluate the patient,
the Geriatric Long-Term Care Review
Committee (GLTCRC) reminds physicians.
This reminder is one of several made by the
Committee after reviewing the circumstances
of the death of a 69-year-old man who lost 33
kilograms in two months while in a long-term
care home.
On March 8, 2013, the man’s weight was recorded as 96.9 kg. Two months
later, on May 10, 2013, it was
recorded as 66.3 kg.
“When rapid weight
The Committee said that
when rapid weight loss is noted
loss is noted a
a broad differential diagnosis
broad differential
should be considered. Appropridiagnosis should be ate investigations and a thorough medication review should
considered”
be undertaken. Along with the
interprofessional team, an appropriate treatment plan based
on the outcome of the assessment should be
developed and implemented.
The cause of death was determined to be
dehydration, due to congestive heart failure and
atherosclerotic heart disease, in a man with cirrhosis of liver.
The Committee noted that the patient was
clearly close to the end of his life when he was
admitted to the long-term care home. He had
end-stage heart failure, had multiple admissions to hospital in the preceding months and
was declining functionally. While the ultimate
outcome would likely not have been different,
the Committee had concerns about the physician’s role as documented in the long-term care
home records.
There was no indication in the records that
the long-term care physician had an overall
plan of care for the patient. It was not clear
that the physician understood the prognosis
for the patient or that he was aware when the
man began precipitously losing weight. If the
physician was aware, the diagnosis and plan was
not clearly documented and communicated. It
was not clear from the records that the physician was aware of the large doses of diuretics
that the patient was taking and the possibility of
significant dehydration.
It cannot be determined from this review if
the physician considered reducing or discontinuing the diuretics. The Committee could
find no evidence in the records reviewed that
the physician had communicated with the longterm care team about the diagnoses, prognosis
and care plan for the patient. Similarly, there
Issue 1, 2015 Dialogue
Issue1_15.indd 37
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2015-03-19 11:18 AM