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?

he had DIRECT contact with bodily fluids of an Ebola patient.

Do you have a link from a credible source for this? I've seen accounts of his helping Ebola patients, but nothing specific about direct contact with body fluids. Given what happens with Ebola, it wouldn't be surprising if that happened -- but I couldn't find a specific witness statement about it.

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Specializes in L&D, Women's Health.
Do you have a link from a credible source for this? I've seen accounts of his helping Ebola patients, but nothing specific about direct contact with body fluids. Given what happens with Ebola, it wouldn't be surprising if that happened -- but I couldn't find a specific witness statement about it.

http://www.nytimes.com/2014/10/02/world/africa/ebola-victim-texas-thomas-eric-duncan.html

Travels, travails of Ebola patient Thomas Eric Duncan - CNN.com

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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.:cheeky:

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.

Yep. This is the issue with computerized charting: Data overload. It is much easier to skip over pertinent info when it is not "in your face" like paper charts, and you are concerned with clicking through multiple screens and pages just to get to your own section/discipline.

In the old ED system, the triage nurses' intake forms were hanging on the clipboard when the physician entered the room. Hard to miss.

I also question why the MD did not put two and two together--patient is from a foreign country and is showing up in your ED. The FIRST thing I would think to ask is " Have you traveled outside of the country recently?"

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Specializes in LTC.

Interesting enough that I took my son to the ER to meet with his surgeon on Friday and was asked by triage RN "Have you or anyone in your family traveled outside of the US in the past 3 weeks" Keep in mind that we live very remotely in the Northeast.

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More today, from the New York Times:

(emphasis mine)

"On Sept. 25, Mr. Duncan began complaining to Ms. Troh about chills, and she drove him to Texas Health Presbyterian Hospital, not far from her apartment. He arrived in the emergency room with a mild fever of 100.1 degrees and reported having abdominal pain for two days, a sharp headache and decreased urination, according to the hospital. When a nurse took his history, the hospital has reported, he said he had not been around anyone ill but had recently been in Africa.

The nurse noted this, but doctors apparently failed to consider the possibility of Ebola for reasons that remain unclear. Mr. Duncan was sent home with antibiotics that were powerless to halt the progression of his virus"

http://www.nytimes.com/2014/10/06/us/ebola-victim-went-from-liberian-war-to-a-fight-for-life.html

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Specializes in Family Practice, Mental Health.

On October 3, Texas Health Resources issued a second news release, much briefer, to clarify a point made in the first one. "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 the physician's workflow. There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event."

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Our local hospital was recently featured in the local paper, demonstrating their readiness for ebola. There was a picture of their negative pressure room, full of all kinds of equipment, and a health care worker posing all gowned and masked. (I think she was supposed to be a nurse but it wasn't clear.) No face shield. The mask was not a fit-tested one; it gaped at the sides. The gown appeared to be a regular semi-permeable one.

I'm not sure if that was the only negative pressure room in the hospital. I would hope the equipment would be stored nearby and only brought into the room if needed, but the article didn't clarify that either. It was a lovely photo-op but somehow I don't feel a lot safer.

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The triage nurses in my ED are supposed to always ask about travel. it has been part of our normal triage process for years. I personally always ask if they have traveled outside the US and if they have travel out of my state.

You would be shocked the number of people who say they have not traveled outside the US and then turn right around and say they have recently been to Mexico.

I even had a pt argue with me and tell me that Juarez is the same as being in the US. She knows this because she grew up in a border town!

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Specializes in hospice.

You would be shocked the number of people who say they have not traveled outside the US and then turn right around and say they have recently been to Mexico.

I even had a pt argue with me and tell me that Juarez is the same as being in the US.

:banghead: You can't fix stupid.

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Specializes in Med/Surg, Academics.
Now the nurse is being thrown under the bus. "Breach in protocol" 2nd person in U.S. tests positive for Ebola | Health - Home

Not "the" nurse talked about in this thread--the ED triaging nurse on Duncan's first trip to the ER. This story is talking about a bedside nurse taking care of Duncan inpatient who has preliminarily tested positive for Ebola.

I hate that they are saying she breached protocol when, during her interview, she could not identify a breach. I would like to know what PPE was being used and the condition of the PPE that she used. The first assumption--without proof--that she breached protocol makes me sad.

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Specializes in NICU, Trauma, Oncology.
Not "the" nurse talked about in this thread--the ED triaging nurse on Duncan's first trip to the ER. This story is talking about a bedside nurse taking care of Duncan inpatient who has preliminarily tested positive for Ebola.

I hate that they are saying she breached protocol when, during her interview, she could not identify a breach. I would like to know what PPE was being used and the condition of the PPE that she used. The first assumption--without proof--that she breached protocol makes me sad.

Yes. I understand it's a different nurse but the nurse is going to take the fall Bc the govt won't admit they might not know what is going on or that their protocol is fallible

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