Patient had a stroke on ward - not recognised

[dolphinmonkey]

I am concerned about my abilities as a nurse due to an incident at my former work place over a year ago and was hoping for your opinions.

I came on shift and noted a patient I had cared for 2 days before (I had been off for 2 days), who at that time had been independent with a frame and talkative was lying in bed with her mouth wide open and looked terrible.

During handover I discussed with the other nurse how poorly she looked. The nurse stated that the night before last (over 24hours ago) she had vomited twice and since then had been unable to walk or eat/drink. She had been reviewed by a doctor since that time and it seemed no clear cause had been noted.

That morning we were short staffed and I had several other patients with issues that I prioritised. The ward round was also late that morning, meaning the patient was not reviewed until nearly 11am.

At this time the registrar approached me and said how long has the patient been with left sided weakness, he stated the patient had had a stroke.

I informed of what the overnight/weekend nurses had informed me. I informed the ward sister that the patient had had a stroke. However this patient did not go down for an urgent CT scan. She was not scanned until later in the shift. She was also not transferred to a stroke unit until that evening.

Looking back I cannot understand why it was not made more urgent immediately the time. I am concerned that the reg would have taken my repeat of the weekend staff's account as well it will be too late to treat. But surely the doctors who reviewed on the weekend would have picked up on a stroke?

The stroke reg who reviewed in the evening was angry that the dayteam had not made the scan more urgent.

Of course looking back I would have highlighted I was concerned about my patient at the beginning of the shift and bleeped the reg. However at the time I told myself well this is ongoing since over the weekend and I waited for the ward round, and prioritised other patients. Do you think this shows a basic lack of judgement as a nurse? At the time I had been qualified for 1 year.

[brownbook]

No it does not show a lack of judgement. Any one of us could have made the same mistake. You are a good nurse to care, to feel "guilty". Many nurses and doctors would blame everybody or everything else and not admit their part in the missed diagnosis.

Honestly the last thing on my mind if I came across the same patient would be "Oh my gosh, she probably had a stroke." You have learned, and by sharing taught us, a valuable lesson, this one wont happen to you again. Unfortunately the nature of working in nursing/medicine is similar situations will arise.

Many patients have gone to doctors for months with vague mild to moderate intermittent complaints of aches, upset stomachs, etc., been put on various treatments or medications, only to finally find out they had cancer.

It is horrible! Decent care providers feel horrible when it happens. All you can do is learn from your "mistake" and keep on providing the best care you can.

[JKL33]

I am concerned about my abilities as a nurse due to an incident at my former work place over a year ago and was hoping for your opinions.

I came on shift and noted a patient I had cared for 2 days before (I had been off for 2 days), who at that time had been independent with a frame and talkative was lying in bed with her mouth wide open and looked terrible.

During handover I discussed with the other nurse how poorly she looked. The nurse stated that the night before last (over 24hours ago) she had vomited twice and since then had been unable to walk or eat/drink. She had been reviewed by a doctor since that time and it seemed no clear cause had been noted.

That morning we were short staffed and I had several other patients with issues that I prioritised. The ward round was also late that morning, meaning the patient was not reviewed until nearly 11am.

At this time the registrar approached me and said how long has the patient been with left sided weakness, he stated the patient had had a stroke.

I informed of what the overnight/weekend nurses had informed me. I informed the ward sister that the patient had had a stroke. However this patient did not go down for an urgent CT scan. She was not scanned until later in the shift. She was also not transferred to a stroke unit until that evening.

Looking back I cannot understand why it was not made more urgent immediately the time. I am concerned that the reg would have taken my repeat of the weekend staff's account as well it will be too late to treat. But surely the doctors who reviewed on the weekend would have picked up on a stroke?

The stroke reg who reviewed in the evening was angry that the dayteam had not made the scan more urgent.

Of course looking back I would have highlighted I was concerned about my patient at the beginning of the shift and bleeped the reg. However at the time I told myself well this is ongoing since over the weekend and I waited for the ward round, and prioritised other patients. Do you think this shows a basic lack of judgement as a nurse? At the time I had been qualified for 1 year.

I don't think you need to be concerned about your abilities as a nurse. It is simply a learning moment.

To be perfectly straightforward, if I came on duty and saw the situation as you described it, that patient/situation would have been my priority unless other residents were somehow in even worse condition. Nothing would change based on my coworker's report to me or the fact that a physician had supposedly seen the patient - because I may not agree with either one of them and may have to do something to advocate for my patient.

Now that doesn't mean I would've immediately guessed this patient had a stroke, but yes, I might even have cut report short to go in there and see what my assessment might yield. Maybe it's the ED nurse thing. What if it were simply that the patient was becoming septic? What if it were any other condition that may evolve over time, so that someone else's previous assessment is completely different than the patient's current condition?

Anyway...those are just a few thoughts. Did your choices cause harm to the patient? I doubt it very much. So just learn what you can from it! We have *all* had our learning moments! :)