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.
Mania can’t be
safely managed
in a long-term
care setting
photo: istockphoto.com
A
review into the death of
a man with a complex
psychiatric history has
prompted the Geriatric
and Long-Term Care Review Committee (GLTCRC) to remind physicians that admission history and
physicals for long-term care residents
need to be done in a timely fashion.
The GLTCRC is a committee of the
Chief Coroner’s office.
The Committee’s review found that
the patient had not been examined
by the long-term care physician until
three weeks into his admission to the
facility. During those three weeks, he
was unstable in terms of his behaviours. There
was no blood work obtained during the admission to long-term care. It is documented that
the patient lost 5.4 kg during those first three
weeks, yet the long-term care physician did not
comment on the loss. In long-term care, the
patient fluctuated between aggression and over
sedation and only five days before his discharge
to hospital was a referral sent to consult the
local psychogeriatric outreach team.
The Committee also stated that the case
serves as a reminder to health-care providers
that a diagnosis of dementia does not mean
that individuals with a lifelong history of
serious mental illness (i.e., bipolar disorder,
schizophrenia, depression) are no longer at risk
of exacerbations of their mental illness.
“Mania is not an illness state which can be
safely managed in a long-term care setting by
primary care practitioners. Individuals with
mania require urgent psychiatric assessment
and further specialized care,” stated the Committee.
Issue 3, 2016 Dialogue
35