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

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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?

Specializes in Oncology, Rehab, Public Health, Med Surg.

Im betting not

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Nurses often get thrown under the bus, when other HCWers commit errors.

I"m sure they do, but that doesn't seem to be happening in this case. In a press release, on October 2, Texas Health said:

"Protocols were followed by both the physician and the nurses. However, we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case. In our electronic health records, there are separate physician and nursing workflows."

http://www.texashealth.org/body.cfm?id=1629&action=detail&ref=1871

Subsequently on October 3(at 9 pm), they issued a "clarification" that said:

"We would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient's travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician's workflow.

There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event."

http://www.texashealth.org/body.cfm?id=1629&action=detail&ref=1872

Sounds like the hospital has major problems.

Found another story suggesting blood testing was not done in a timely fashion:

http://www.dallasnews.com/news/metro/20141003-ebola-case-blood-test-delay-may-have-violated-federal-guidelines.ece

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Specializes in Med/Surg, Academics.
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!

Thank you! When ID has been consulted on a case, one of the first questions I hear them ask is about any recent travel. It's in every single note they do as a pertinent positive or pertinent negative. To me, it's like a pulmonologist asking about smoking history...basic stuff here. In the ER, I think it would be a very basic assessment for a provider when a patient presents with a fever.

I see a lot of corner-cutting doctors, but there are basics that should always be done. Travel history on a possible infectious process seems like one of them. In my workplace, the big corner-cutting on admission is obtaining last dose information for PTA meds. BASIC! Then the admitting floor nurse has to do it because pharm won't approve any meds until it's done. So many errors I've found, I'm not even gonna elaborate....

I would argue that triage nurses do not necessarily have to ask about travel history, that is before all this happened and the CDC started recommending it for early detection and rule outs. Triage nurses determine acuity and where people fit in the waiting line. HPI is the domain of the assigned doc and the intake nurse.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I"m sure they do, but that doesn't seem to be happening in this case. In a press release, on October 2, Texas Health said:

"Protocols were followed by both the physician and the nurses. However, we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case. In our electronic health records, there are separate physician and nursing workflows."

Ebola Update, Oct. 2, 8:35 p.m. CDT - Arlington - Texas Health Resources, Dallas, Fort Worth, Metroplex, Texas (TX)

Subsequently on October 3(at 9 pm), they issued a "clarification" that said:

"We would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient's travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician’s workflow.

There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event."

Clarification from Texas Health Resources, Oct. 3, 9 p.m. CDT - Arlington - Texas Health Resources, Dallas, Fort Worth, Metroplex, Texas (TX)

Sounds like the hospital has major problems.

Found another story suggesting blood testing was not done in a timely fashion:

Ebola case blood test delay may have violated federal guidelines | Dallas Morning News

They came back and wanted to do damage control...saying there was a flaw is screaming LAWSUIT! to anyone who now becomes infected form this man. They were foolish to speak out like that.

Too late cat's out of the bag.

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Specializes in Med/Surg, Academics.
They came back and wanted to do damage control...saying there was a flaw is screaming LAWSUIT! to anyone who now becomes infected form this man. They were foolish to speak out like that.

Too late cat's out of the bag.

But by saying that the system was not the flaw, aren't they indeed setting the scene to blame a person for not recognizing the information? In other words, save the organization and let the lawyers go after a person?

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Specializes in School Nursing.

I have to agree that the PATIENT is the one who should shoulder the responsibility, first, for lying when coming into the states, and then failing to tell the ER not only had he recently been to Africa, that he had DIRECT contact with bodily fluids of an Ebola patient.

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Specializes in MICU - CCRN, IR, Vascular Surgery.
I have to agree that the PATIENT is the one who should shoulder the responsibility, first, for lying when coming into the states, and then failing to tell the ER not only had he recently been to Africa, that he had DIRECT contact with bodily fluids of an Ebola patient.

I agree with you, but you know the saying "the customer is always right"... Sorry, I'll try and decrease the cynicism now.

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Specializes in L&D, Women's Health.

Posted this on the other thread but is more appropriate here . . .

Good!! Now, why can't the press make this more visible! Notice how this statement is sort of buried at the end of the article:

"On Thursday, the hospital elaborated by saying that a flaw in the electronic health records systems led to separate physician and nursing workflows and that the doctor hadn't had access to Duncan's travel history.

But the hospital issued a statement late Friday saying that the doctor who initially treated Duncan did have access to his travel history after all."

News from The Associated Press

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I am betting RN TOLD physician but may not have explicitly charted that. Physician probably "doesn't remember" being told. Really Ebola and travel to Africa is definitely on everyone's radar. This physician should have been doing his or her own H&P in addition to nursing's triage notes. I think this hospital is full of it. They are trying to save their own rear end. That is certainly nothing new.

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Specializes in L&D, Women's Health.

I am ashamed to admit that I am one who was throwing the RN under the bus. I simply could not believe that a nurse, knowing someone from Liberia presenting with fever, would not alert everyone. What is worse is that I was thrown under the bus by the media years ago and should've known better! Hanging head . . .

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Good!! Now, why can't the press make this more visible! Notice how this statement is sort of buried at the end of the article:

"On Thursday, the hospital elaborated by saying that a flaw in the electronic health records systems led to separate physician and nursing workflows and that the doctor hadn't had access to Duncan's travel history.

But the hospital issued a statement late Friday saying that the doctor who initially treated Duncan did have access to his travel history after all."

News from The Associated Press

In some cases, the hospital's change of story was the headline:

http://www.nytimes.com/2014/10/04/us/containing-ebola-cdc-troops-west-africa.html

Dallas Hospital Backpedals On Reason For Releasing Ebola Patient

Dallas Hospital Alters Story on Ebola Case

http://www.dallasnews.com/news/metro/20141003-hospital-reverses-explanation-for-fumbling-ebola-case.ece

WSJ buried it:

U.S. Tracking People Exposed to Dallas Ebola Patient - WSJ

Atlantic Wire said patient was sent home because of "bad software" but read the comments -- the hospital's backpedaling is noted by readers, so clearly the story is out there.

The Ebola Patient Was Sent Home Because of Bad Software - The Atlantic

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Specializes in Family Nurse Practitioner.
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?

When I first heard the report on NPR I said to myself "of course they blamed the nurse."

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