i am taking a class where we need to analyze a legal malpractice case. i was just wondering what everyone think of this. sorry for the length but i feel that there is a lot to be learned for this case. thank you for your replies.
the patient was a fourteen year old male with multiple medical conditions. specifically, the patient was a quadriplegic, nonverbal and nonambulatory. he had a history of seizure disorder and at the time in question was npo. feedings were given through a gastrostomy tube.
the patient was on an apnea monitor due to an obstructive respiratory condition that required a tracheostomy to be placed.
there were specific orders from the physician that the sleep apnea monitor be turned on "at all times" that the patient was not directly observed.
this would soon present an annoying problem for the nursing staff. under normal conditions, the monitor could "alarm" for no reason, or if the patient held his breath for a moment or two. the patient would frequently use this as a "trick" to get the nurses to come and check on him. at one point, the nurses began to turn the monitor off routinely.
this was soon noticed by the physician and prohibited. he pointed out that the monitor was set to alert the nurses to episodes of tachycardia and bradycardia that the patient was at risk for.
when the nurses continued to turn the monitor off despite the order documentation of the monitor's status was made a requirement of the nursing staff. in other words, each nurse on during a shift would need to document that it was in fact on and in use. this made the nurses individually accountable for the monitor's proper use.
despite these measures, an lpn on duty discovered the patient with his tracheostomy tube displaced and with no pulse or respirations. the patient would be coded, and transported to a nearby emergency department where the pronouncement of death was made.
the nurse stated that the alarms had not sounded and when cardiac leads were removed to begin cpr, there were also "no alarms" heard. other testimony would state that lights on the monitor were flashing, the accuracy of this observation was doubtful.
when the case went to court, curiously, the "monitor" of that day was "missing" from the chart.
the parents of the 14-year-old child would sue the facility for medical malpractice and negligence. the court's verdict found for the plaintiffs and granted a large award.
the defendants appealed.
questions to be answered:
1. were the nurses responsible for the status of the monitor and documenting that it was working properly.
2. were the nurses responsible for the wellbeing of the patient who was a total care patient and unable to care for himself.
3. were the nurses responsible for documenting that the sleep apnea monitor was working properly and having that documentation available in the chart.
the court and jury noted that the nursing staff of the facility had already been reprimanded for "shutting the monitor off" on several occasions. this was with the full knowledge that this action could put the patient at risk of distress.
at the time of the incident, the patient clearly was experiencing respiratory and cardiac distress that would otherwise have been picked up by the monitor and sounded an alarm.
testimony on the equipment itself stated that it was in perfect working order. it was added that even with normal operation, incessant "false" alarms could not be avoided. it was this "alarming" that prompted the nurses to shut the monitor off in the first place. this had prompted the physician's order to keep it on at all times and that the nursing staff "document" that it was turned on and in use.
the responsibility of the nurse to monitor a patient's status and report any changes or distress to a physician is basic to nursing practice. this is mandated in state nurse practice acts and nursing[/url] standards.
the nursing documentation of the monitor's use, mandated by a direct and specific physician order, was "missing" from the day in question. this in addition to nursing testimony that "no alarms were heard" and conflicting testimony about "lights flashing" shed considerable doubt on the credibility of the nurses.
the appeals court affirmed the judgement of the lower court stating that the evidence against the defendants was grossly in favor of negligence.
events in a facility are sometimes beyond the control of the nurse. a patient[/url] can code, or go downhill despite the best intentions and care of the nursing[/url] and medical staff.
in this instance however, deliberate negligence on the part of the nurses resulted in a death that was clearly avoidable. had the monitor been used as intended, it is entirely possible that the patient's condition could have been picked up promptly and a tragedy avoided.
if the facility or family in this case wished to file formal charges with the state board of nursing, it is likely the nurses involved would lose their licenses. it is likely that a formal complaint could involve not only the nurse on shift during the incident, but all the nurses caring for the patient up until that point.
to turn off a potentially life-saving monitor because it "made too much noise" is simply inexcusable. a policy might offset losses in this case by covering legal expenses and damages to the family. it would not however save the nurses from losing their licenses following a formal board inquiry.
ZASHAGALKA, RN
3,322 Posts
One of our standards or care is that EACH nurse is require to reassess the alarm limits and status at the beginning of EACH shift. If another nurse turned off (or changed the parameters) of the alarm and the CURRENT nurse didn't catch it and correct it if THEY felt it should be on (or re-adjusted), then THAT nurse, and only that nurse is responsible for the fact that the alarm is off (or set incorrectly), for their shift.
In fact, you cannot complete the assessment documentation in my unit without addressing whether or not you personally assessed alarm status and limits.
You cannot hold other nurses responsible for the actions of the nurse at the time an event occured because of 'alarm status'. That status is the personal responsibility of each nurse, at the beginning of each shift.
Maybe, just maybe, this would be an issue in the 'transitional' period between shifts. It would not, however, be an accountable action for a series of nurses in previous shifts.
~faith,
Timothy.