I recently had a situation occur where a patient that I cared for during my shift was airlifted to another facility r/t a pneumothorax during the next shift. While I cared for her, the vitals were stable and oxygen saturation above 90%. The initial diagnosis was pneumonia. Apparently the doc was upset that I did not notify him of "how bad" the child was during my shift. However, she was stable the entire time and I documented my vitals as such. I did have to place her on oxygen once she fell asleep to maintain the sat greater than 90%, but this is generally a normal intervention with pneumonia, and the MD gives orders for this prior to it occurring. Respiratory also assessed the child when the oxygen was initiated. I guess what I'm asking is... should I be worried that legal action could be taken against me since the child got worse within the hour after I left my shift? The nurse who followed me said she was not maintaining her sats at the time that she did her initial assessment. She tried a few interventions herself before the child was airlifted (none of which helped raise oxygen level). Another note - the mother was with the child the entire shift and never expressed any concern of worsening condition. I know a pneumothorax may happen quickly, but I'm so worried! It's like she got worse right at shift change. I cannot quit thinking about this child.
Feb 26, '14
Children can have rapid changes. All peds nurses realize that. It is quite possible there was a change in condition from your last set of vital signs to the oncoming nurses initial assessment. I once had a physician tell me that "each time we go into the room, we potentially assess a different patient." He was referring to his daily physician rounds, but it's true of nurses too.
My first pneumo patient was breathing in the 80's with sats below 90 on my first assessment. I had received in report that they were stable. I honestly didn't have time between frequent assessments, calls to the physician, and stat orders to worry about whether or not the child was stable a couple of hours before. I haven't questioned it since either. I have to trust in the skills of the nurse who had the patient before me and deal with the patient condition that I personally assess at the time I care for my patients. Just like if it wasn't done you can't chart that it was - if I wasn't there, I can't tell you that they were different than what was reported.
Don't stress it. As for worrying over the legal ramifications...if you do that every time a patient goes bad after you've had them, you will burn yourself out very quickly. Some things you have to just let go, study what you did wrong (if anything), process the situation, learn from it, and improve from there.
Last edit by hunnybeeRN on Feb 26, '14