Will the Texas ED RN become a scapegoat in the Ebola patient discharge?

[preddish]

I am sure you have all read about the Texas Ebola patient's erroneous discharge from the ED. All of the articles I've read allude to the RN as being the major cause of this error. I am very concerned that he/she will become the sacrificial lamb to pin the blame on and have negative consequences for this nurse rather than being a systems' issue. Since Ebola is such a hot issue and concern shouldn't casefinding be the responsibility of all the professionals who encounter any patient when they enter the healthcare system?

[herring_RN, ASN, BSN]

U.S. nurses say they are unprepared to handle Ebola patients

Nurses, the frontline care providers in U.S. hospitals, say they are untrained and unprepared to handle patients arriving in their hospital emergency departments infected with Ebola.

Many say they have gone to hospital managers, seeking training on how to best care for patients and protect themselves and their families from contracting the deadly disease, which has so far killed at least 3,338 people in the deadliest outbreak on record...

... Dr. Edward Goodman, an infectious disease doctor at Texas Health Presbyterian Hospital in Dallas that is now caring for the first Ebola patient to be diagnosed in this country, believed his hospital was ready.

The hospital had completed Ebola training just before Thomas Eric Duncan arrived in their emergency department on Sept. 26. But despite being told that Duncan had recently traveled from Liberia, hospital staff failed to recognize the Ebola risk and sent him home, where he spent another two days becoming sicker and more infectious.

"The Texas case is a perfect example," said Micker Samios, a triage nurse in the emergency department at Medstar Washington Hospital Center, the largest hospital in the nation's capital...

... Nurses argue that inadequate preparation could increase the chances of spreading Ebola if hospital staff fail to recognize a patient coming through their doors, or if personnel are not informed about how to properly protect themselves...

... Samios said she and other members of the emergency department staff were trained just last week on procedures to care for and recognize an Ebola patient, but not everyone was present for the training, and none of the other nursing or support staff were trained.

"When an Ebola patient is admitted or goes to the intensive care unit, those nurses, those tech service associates are not trained," she said. "The X-ray tech who comes into the room to do the portable chest X-ray is not trained. The transporter who pushes the stretcher is not trained."

If an Ebola patient becomes sick while being transported, "How do you clean the elevator?"

Nurses at hospitals across the country are asking similar questions...

... Sean Kaufman, president of Behavioral-Based Improvement Solutions, an Atlanta-based biosafety firm, helped coach nurses at Emory University through the process of putting on and taking off personal protective equipment (PPE) while they were caring for two U.S. aid workers flown to Atlanta after becoming infected with Ebola in West Africa.

Kaufman became known as "Papa Smurf" to the Emory nurses because of the blue hazmat suits he and others wore that resembled the cartoon character.

"Our healthcare workforce goes through so many pairs of gloves that they really don't focus on how they remove gloves. The putting on and the taking off doesn't occur with enough attention to protect themselves," he said.

Nurses say hospitals have not thought through the logistics of caring for Ebola patients.

"People say they are ready, but then when you ask them what do you actually have in place, nobody is really answering that," said Karen Higgins, a registered nurse at Boston Medical Center.

Higgins, an intensive care unit (ICU) nurse, said hospital officials have been teaching nurses on one of the regular floors how to care for an Ebola patient.

"I said, well, that's great, but if the patient requires an ICU, what is your plan," she said. "They looked at me blankly."...

http://www.reuters.com/article/2014/10/03/health-ebola-nurses-idUSL2N0RX35F20141003

[MunoRN, RN]

Supposedly it was a system error. The nurse did recognize the patient had recently travelled to Africa and included that in the triage charting. Apparently the problem is that in this ER the nursing staff charts in one system and the physicians charts in another and only some of what the triage nurse charts populates the charting that the physician sees.

http://www.buzzfeed.com/jimdalrympleii/texas-hospital-says-flaw-contributed-to-ebola-patients-relea#2yxzo4o

[applewhitern, BSN, RN]

I agree with Munro~ apparently the nurses see one chart, and the physicians see another one, in their computer system. However, now they are claiming the problem has been fixed. Personally, I think the nurse should have called the medical person to make sure this wasn't overlooked, and initiated isolation and protective measures.

[SubSippi]

It's clear that this oversight was due to mistakes made by several different people. The RN may be included in this group, but is certainly not the only one. Hospitals have people who handle their publicity, and I'm sure that they intentionally spun the story to make it seem like the RN should shoulder most of the responsibility. It would make the hospital look much worse to blame a physician, or to admit that there were not effective policies in place, their charting system is ineffective, and that this screw up was a team effort.

[Esme12, ASN, BSN, RN]

When the ED was switching to computerized charting this was a BIG bone of contention with me. The triage is just that...the MD chart in a completely different system. I was referred to as "chicken little" by administration and "resistant to change".

I was told that the MD's would of course "look at all triage notes" as a part of the H&P and initial assessment of the patient...Uhm...right...physicians are always compliant.

If any of you are reading...told you so.

All that aside the MD has to perform a complete history and physical...how did he miss this in his initial assessment? Seems to me he should be as oriented and prepared as the nurses...if not more so!

Yet again....the one who does not bring revenue is the scapegoat thrown under the bus.

[T-Bird78]

Initially the nurse had tire marks on her back from being thrown under the bus, but the hospital did FINALLY admit that it was an error on their end with the computer charting system. So many people in a non-medical setting were commenting on online articles saying that nurse needs to be FIRED and her head on a silver platter but I knew there was something more. I was so relieved when the hospital finally acknowledged they screwed up and not one single person. Prayers for a full recovery and that the nurse and hospital staff/pts/visitors didn't get it.

[BeachsideRN, ASN]

I'm not even a nurse yet and I know that doctors rarely read their own notes much less any of the nurses notes, unless it's blaring right in their face and blinking and they have to do something in order to make it disappear....

There was so many fails with this particular Ebola patient. Starting with the patient himself. He lied to officials in Liberia in order to get on the plane. He knew he had been exposed and (speculating) I think he came here in order to get treatment (end speculation). There was the whole ED debacle the first time he was admitted. Which if it was me and I thought I had Ebola I would not only tell the triage nurse I had come from Liberia - so there is some patient liability here as well. Then I've read that his family that is under quarantine is not being compliant and keep leaving the home. This is gonna get ugly, quick.

[Semolina]

The hospital's story appears to have changed.

From the NY Times:

"Health officials’ handling of the first Ebola patient diagnosed in the United States continued to raise questions Friday, after the hospital that is treating the patient and that mistakenly sent him home when he first came to its emergency room acknowledged that both the nurses and the doctors in that initial visit had access to the fact that he had arrived from Liberia."

To me, this appears to put more blame on the doctors, since they are responsible for medical diagnosis.

ETA: Apparently the hospital involved was recognized by US News and World Report in 2012 for having "met three challenging standards that put them in the vanguard of centers leading medicine into the era of electronic medical records (EMRs)."

http://health.usnews.com/health-news/most-connected-hospitals/articles/2012/07/16/most-connected-hospitals-the-list

Here is what Texas Health had to say about this recognition:

http://www.texashealth.org/mobile.cfm?id=4769&action=detail&ref=1392

[caroladybelle, BSN, RN]

Most connected doesn't mean jack, if your HCP providers don't use it properly.

When I originally heard about the case and that a triage nurse "dropped the ball" by not involving "all" members of the team, my first thought was, s/he told the primary care providers that should have told whom ever followed them. And obviously that did not occur.

That is why I take a measured view. Nurses often get thrown under the bus, when other HCWers commit errors.

[Lennonninja, MSN, APRN, NP]

I'm betting that the nurse loses their job and the doctor is commended for eventually making the diagnosis. But I'm a huge cynic so...

[duskyjewel]

If anyone in my family gets Ebola, I can tell you what organization will appear at the top of my lawsuit paperwork.....