Nil by mouth error

[littlehobo]

Hi, a quick bit of guidance on this situation would be appreciated, as I need it for an essay

I was working on a surgical ward in the UK and half way through a shift, just before lunch was told that a patient who had been waiting for a week for her op could go down to theatre in the afternoon. I immediately made her NBM and told the Nursing Assistant working at my end of the ward. I also hung a Nil By Mouth sign above her bed and explained the situation to the patient.

About 20 minutes later I found the patient happily eating lunch. Her Op had to be cancelled and was delayed by about 3 days. The meal had been given to her by an agency Nursing Assistant, who had not worked with the patient that day and had not seen the NBM notice. The patient seemed to have a degree of short-term memory loss.

Question is, who is responsible for the patient being fed? Me, or the agency NA?

Any tips would be cool.

[unknown99, BSN, RN]

Both are responsible. The agency nurse aidefor not "noticing" the sign, which was clearly posted, and yourself, if you were the one in charge. It was an honest mistake, but mistakes do not hold well in nursing.

[pricklypear]

I'm not sure how you could be held responsible, if a big deal were to be made of it. It seems you did everything you needed to. Nursing assistants need to be held accountable for their own actions, you can't stand over your patient until she goes to surgery to make sure she doesn't eat (unless she is your only patient and you have nothing better to do - Hahaha.) Patients need to be held accountable also, you informed her of her surgery, and she ate anyway. Maybe you should speak to the agency the aide came from about further education of their employees.

[safewaygreenbox]

I would put in an incident form.

Kay the 2nd :)

[littlehobo]

All the incident type stuff has been done, it happened a couple of months ago, I just have to write an essay on accountability and thought this would make a good example! Might pretend it wasn't me though.... :chuckle

[pricklypear]

Accountability for different healthcare workers is a really great subject for an essay. The problem that you had (although it was an unintentional occurance) brings to light how nurses seem to be responsible for EVERYTHING that happens to a patient on their shift. I don't think this is true. You fulfilled your accountability by informing the patient, the nurse aide on you side, and posting a sign. A nursing assistant does not work under my license, she/he has her own. However, I AM responsible for his/her actions if I delegate an inappropriate task, or have knowledge of mistakes and do nothing about it.

[dbsn00]

Similiar thing happened to me a few weeks ago - resident has 9:15AM appt. for CT with contrast, to be NPO from 5AM on. CNA told more than once (the day before, upon arrival of shift that AM & during report), large sign hung above bed, kitchen also notified (resident is confused so even though he was informed he couldn't be counted on to remember). Kitchen brings up breakfast tray, CNA who "forgot" gave tray to resident. I was the only one held responsible as I was the charge nurse

[pricklypear]

I'm sorry, I just cannot understand where it is written that I am responsible for everybody else's mistakes. As I said before, CNAs work under their own certification or license, and should be responsible for their own actions. Nurses can't be everywhere at once, making sure nobody screws up. I think it's just easier for everybody to have one person to blame:the nurse, "since she's in charge" Hopefully it was documented that the CNA was informed, and appropriate signs were placed.

[Lawnurse]

I agree w/ Pricklypear that the NA is operating under her own license, not yours, so you are not liable.

And you didn't "delegate" the passing of the tray to the NA for two reasons

1) that's not a nursing duty, any unlicensed person can do it

2) you can't "delegate in the negative." You can't delegate for someone *not* to do something.

IMHO, the person at fault is the *patient.* Unless there is a reasonable explaination for why she took the tray (she dementia, alzheimer's, language barrier), and/or unless she honestly believed that the reason the NA gave her the tray was because the NPO/BDM status suddenly no longer applied, it was her doing.

But that was her right as a patient. She is not required to do anything she is told to do by a nurse/MD/other staff, and she is not required to NOT do anything she is told not to do.

I don't see why *you* get blamed for the patient asserting her legal right. As long as you made it clear to her that the NPO status was *for the purpose of surgery,* she knowingly took action to delay her surgery - which is her legal right. If your patient was a competent adult, your facility should treat her like one.

Oh, wait, I remember...because nurses take the blame for EVERYTHING. :angryfire

- Lawnurse (doing my small part by defending this rediculous "legal fiction" whenever I can.) :uhoh21:

[pricklypear]

Lawnurse: Finally, the voice of sanity! I wish more of us would stand up to this stuff, and refuse to take the blame for certain things that are beyond our control. As long as nursing as a profession is going to bend over and take it, they will keep giving it to us!