Procedural advice needed urgently

[Sylvia SA]

Hi

I am a Registered Nurse in South Africa and in a predicament and would appreciate some advice from the Nursing community across the globe as to the normal procedure across the globe. Briefly This is what happened.

I admitted a patient to hospital for an orthopaedic procedure (hip) that was to take place the next morning Approximately 18 hours later. On admission I followed the normal admission procedures and asked the patient if he had any open sores or any thing that could cause infection. He responded and said no. I did not do a physical examination of the area to be operated immediately. I thereafter had nothing more to do with the patient as I went off shift. The patient was prepped for theatre by one of my colleagues. The following morning on arrival at the theatre, The surgeon found a pimple on the lower part of the abdomen and cancelled the procedure. I realise with the risk of infection why the procedure was cancelled. Certain costs were incurred by the hospital and now I have been charged with Gross Negligence.

1) Is a physical examination of the area to be operated done immediately on admission or when preparing the patient for theatre.

2) Do my actions constitute Gross Negligence?

3) What constitutes gross negligence in such a scenario?

I urgently require answer to these questions as I have my disciplinary hearing tomorrow. All constructive criticism is appreciated.

Thanks

Sylvia

[Renee' Y-Y]

In the United States, all patients are assessed upon admission, and at the beginning of every shift thereafter and as needed. It would also seem that your colleague did not assess the patient either. I am rather ignorant of the scope of practice for nursing in other countries...I would say in this country it is quite liberal. I'm not sure this country would call off or postpone a surgery because of a zit (pimple) though either...eating/drinking...yes. Gross negligence seems way out of line here...at least in this country. No permanent harm has been done to the patient...you have no control over that zit...and whether you found it or the doctor found it...doesn't change the fact that the procedure has been postponed. I gotta tell you...this whole thing is crazy...sounds more like a pissed-off doctor than anything. So far, in this scenario...in my opinion...there is no gross negligence. If it was that big of a deal, why didn't the physician examine the patient as well?...or your colleague...she did the actual prep...right? Best of luck. Keep us posted.

[canoehead, BSN, RN]

I wouldn't report a pimple, and have seen people go to surgery with much worse. I agree that the onus is on the doc to examine the patient thoroughly before scheduling the surgery. The accusation against you seems ridiculous to me, although in your shoes I WOULD have done a thorough skin assessment to look for potential/actual areas of skin breakdown. Scrapes and bruises can turn nasty if not noticed early.

[Lysa]

a complete physical exam should have been done-yes-but to cancell surgery over a zit? How bizarre!

[suzanne4, RN]

A "zit" on the abdomen is not normal. It means that there is some type of infective process going on in that patient. It doesn't specify what type of orthopedic procedure wa to be done, but if a joint replacement, definite ground for cancelling the surgery. And really any other surgery, especially ortho. You get an infection at the bone level, and you are going to be on 6 weeks of IV antibiotics.

Was it grounds for "gross negligence? Not in my opinion. They were just looking for a scapegoat? And those "zits" can appear rather quickly, sometimes not even there the night before surgery......................

But why was it allowed to get that far?

[suzanne4, RN]

Remember that most "zits" on the body are caused by some type of staph infection.

[gwenith, BSN, RN]

I too found this weird - here the onus for assessment falls more on medical shoulders than nursing.

As for the "pimple" it depends on what and where this pimple was. As the Sylvia is from South Africa there are a lot of things it could be up to and including a grass seed abcess (boy have I seen a few of those here in Aus).

Gross negligence - no and what is the impact on the other nurse - what disciplinary action are they taking against her?? Please log back on and keep us updated Sylvia - hoping all works out well for you.