1.) I have recently started my nursing career but when asking a colleague about a medical malpractice scenario that they experience, I was quickly informed about this negligent malpractice situation. In this specific scenario, this malpractice resulted in fatality to the patient. My colleague used to work in the emergency department as a registered nurse for 15 years before she transferred to a slower pace setting on the cardiac unit. During the 15 years, she will never forget this one clinical situation that resulted in death to a patient in the hospital parking lot. This patient was in the emergency room due to heart failure exacerbation. The colleague wanted to clarify that this situation occurred over 10 years ago. This individual was obese and have +2 bilateral edema in the lower extremities. This patient was often in the emergency room due to noncompliance to medication regimen. The doctor came and assessed this patient and determined that Lasix, that wasnt taken in multiple days, would be sufficient for this patient as she was asymptomatic and just had fluid in legs. This patient was complaining of a pain in her lower extremities that was throbbing. This was brushed off due to this being a common complication of edema. The doctor didnt want to obtain any type of ultrasound to further assess the situation so the patient stayed overnight in the ER due to no available beds and was discharged the next day. All the patients cardiac test and labs came back normal with no changes since last admission. The patient that night received morphine to help with the pain that was being experienced in her legs. The edema was drastically reduced in the morning and the patient received one last dose of pain meds 2 hours before discharge. The doctor was aware of this pain but felt as if further testing wasnt needed despite the complaints. The patient was signed off and as she was walking to her car with her daughter, she felt a stabbing pain in her chest and fell to the ground. The patient suffered a massive pulmonary embolism in the parking lot and died immediately.
2.) This doctor violated all the four elements of malpractice. This doctor had a professional duty owed to the patient to provide optimal patient care to promote the health and wellbeing. According to the AMA Principle of Medical Ethics (n.d.), this doctor in this scenario committed a breach of duty as he is responsible to promote the wellbeing of the patient and collaborate in discharge planning to ensure its safe. This doctor failed to promote the wellbeing of the patient didnt order any further diagnostic tests to detect any DVTS. This medical negligence of ignoring the patients complaints of pain in the lower extremities and didnt order further testing resulted in death to the patient from a dislodged DVT that turned into a PE.
3.) The colleague reported that there was a root cause analysis performed as the patients family was suing due to a death that couldve been prevented if it was caught in time or if further diagnostic tests were done. The root cause analysis was performed to collect the data that was performed for this patient when the patient was admitted. They identified the possible factors that couldve influenced the development of this DVT and the reasons why this issue wasnt identified. This medical negligence that was exemplified here couldve been prevented if the doctor wouldve ordered the proper diagnostic tests such as a bilateral lower extremity ultrasound or further investigate the pain in the lower extremities rather than addressing it with a PRN analgesic. This root cause analysis was performed to address the discrepancies that were made that resulted in fatality to the patient.
4.) There was no specific policies that were put into place after this negligence occurred but there was reinforcement about listening to the patient and advocating for the patient if you feel that something is wrong. In this scenario, the nurse of the patient couldve advocated to the doctor directly about the patient and the pain that she was experiencing. If the nurse felt as if the doctor was not listening to her about the patients concerns, the chain of command should be followed as this shouldve been addressed during the admission.
AMA Principles of Medical Ethics. (n.d.). CHAPTER 1: OPINIONS ON PATIENT-PHYSICIAN RELATIONSHIPS. Retrieved from https://www.ama-assn.org/sites/ama-assn.org/f/files/corp/media-browser/code-of-medical-ethics-chapter-1.pdf
1. My example of malpractice did not happen to me personally, but is tragic. The patient was in a long term care facility and was on daily antihypertensive medication. This medication required monitoring of blood pressure before administration. The nurse was having a busy morning, and somehow gave the medication without knowing the patients blood pressure. Relatively soon after, the patient lost consciousness and collapsed while ambulating, due to hypotension. They were horribly injured, with several fractures, had a lengthy recovery, but were otherwise unhurt.
2. The four elements of malpractice were present. The nurse had a clear duty to the patient to competently administer medication. A breach of that duty was present when the nurse did not uphold the standard of care. It would have been prudent and reasonable for the nurse to verify blood pressure before administration, and withhold the dose if indicated. Harm clearly occurred in the form the clients injuries relating to losing consciousness. Finally, the causal relationship is clear: the clients injury would not have happened if the nurse had not breached their duty.
3. A root cause analysis was performed. An incident report detailing the causes of the accident was generated by the nurse and reviewed by management. The nurse was distracted while administering the medication and did not pay attention to important information. The CNAs also did not take vitals appropriately that day. As a result of the blameless root cause analysis, the nurse did not meet with disciplinary action. Incident reports should be used to create systems that do not rely on the nurses awareness alone (Härkänen et al., 2017), so it was more constructive for the facility to adjust ratios and strains on floor nurses instead of resorting to simple administrative discipline.
4. This incident occurred when paper charting was still in use. The facility upgraded to electronic systems, which require the nurse to input vitals and scan barcodes on medication before it can be administered. This does not substitute for the nurses duty to the patient, but it does create an added safeguard and helps prevent future incidents.
Härkänen, M., Saano, S., & Vehviläinen-Julkunen, K. (2017). Using incident reports to inform the prevention of medication administration errors. Journal of Clinical Nursing, 26(21-22), 3486-3499. https://doi.org/10.1111/jocn.1371
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