Originally Posted by CritterLover
There are already three threads on this -- one in Nurisng News, one in the ER forum, and one in General Discussion.
While it is a tragic, unfortunate, event, I cannot place all of the blame on the triage nurse, as many are trying to do.
To me, several things stand out:
1. This hospital had many issues.
2. The patient had been discharged four hours earlier, and had been seen at least three other times recently.
3. When I am in triage, I am going to see the patients that haven't had an MSE before I'm going to see those that have just had an MSE. You have to be able to trust in the other teammemebers (docs, midlevels) that they are doing a thorough MSE. It is one thing to say that patients are instructed to "return to the Er for increased pain, concerns" etc....she had already done that, and had already been seen again.
One of her earlier dx had been gall stones......very painful, but not usually life-threatening (generally, the galbladder has be becom blocked/and/or gangrene before it becomes life-threatening). Since her autopsy revealed ruputured diverticulum, it seems as though one of the docs missed something.
I have to also wonder if she was referred to a surgeon, and if so, did she follow-up.
Also noted is that her autospy revealed + meth.
I'll see if I can find the other links for you.
Her + Meth is completely irrelevant.
I guess I'm just a different kind of thinker but I am more likely to see a patient who is writhing on the floor and screaming in pain before I see patients who are presenting less dramatically - if for no other reason than so no one thinks I'm intentionally ignoring her or trying to get her to shape up and conform to my standards of how ER pts should behave.
Put my license in the hands of other team members? Be they aides or docs, not any time soon.
I agree that the docs made grievous and fatal errors in their exams and I hope they are held accountable for anything they should have and could have done differently. However, the Triage Nurse's decision to not re-evaluate was so dead wrong. Even other waiting room patients were trying to get the woman seen but the TN stubbornly refused.
I don't care if someone has been seen 30 times or 300 times. She needed to be seen again. All the TN had to do was get her screened and turn her over to the doc. She'd have been in the clear. But she refused to budge and now she is having to pay the price for her stubborn refusal to re-evaluate the woman.
As for the OP's boss posting this in their ER, well, I hope she and her colleagues put their concerns in writing and send a letter, with a copy of this article and any others like it that they can find, to their boss, and that one's boss, and the next boss up the line, and up the Administrative ladder, too, etc., all the way to the Board of Dir's, also to Risk Management, until their concerns are addressed. Even if nothing changes, they will have gone on record as having made their concerns known. Maybe JCAHO and CMS need to know, too.
Would you like to comment?
