Your worst nightmare

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I was tempted to call this story the 'no name story' so as to avoid being accused of misleading or creating 'click-bait.' But this time, I actually think what I'm about to tell you, has to be your worst nightmare. I also hope to give plenty of detail, so you get a clear picture.

It happened to a good friend, in the same A&E department, in a poor part of east London.

The hospital was in a poor neighborhood, and 2/3 of the patients first language was anything but English, many people were on government support, and the neighborhood was not the safest in daylight, let alone night time.

Regardless, myself and many fellow kiwis and aussies worked there as agency/temp nurses, especially night shifts, due to the regular work, as well as the large number of fellow antipodeans. On any given shift, half the staff were agency.

I'd spent 6 months working there, with a good friend Amber (not her real name) who was a very skilled, hard working nurse. She was manning the acute assessment unit - this unit ordered bloods/ecg's etc, so by the time a patient got to the doctor, they had something to work with.

So a 50yr old African man walks in with chest pain, and is sent to Amber. The pain is only on movement, no SOB, good colour, not cold/clammy/sweaty, in fact looks well. His ECG is normal, and he is in no pain when lying on the bed. The pain is left and right sided, and only returns when he moves ie got up from the bed.

It turns out he'd begun a weight training program the day before, and he'd been doing bench presses. His CK was a little elevated, but his tropinin normal (I can't remember which specific one, and I know they've got more accurate testing these days) but as the pain had begun the morning after the workout, and it was now evening, everything seemed ok.

The patient was a non-smoker, and had no previous medical hx of note.

Amber felt it unlikely to be cardiac, but of course ran the results and history past the doctor. The doctor signed the ECG to say he'd reviewed it, put a time and date, and said he could be a category 3 (which meant about a 2hr wait).

Anyway, the patient and his wife don't feel like waiting, especially as all the tests seem fine, and they ask Amber if he's okay to leave. She tell them they still need to see the doctor, as it's not her call to make.

The family wait 2hrs, only for the department to be swamped with some nasty traumas, and the doctor wouldn't be seeing them anytime soon. Amber kept checking on him, and he'd had no further pain (unless he stretched or moved a lot) and felt fine, and they decided to leave. They didn't sign a self-discharge form.

The next night, Amber and I are in resus when an ambulance blue lights in a patient, and Amber finds herself doing compressions on the man from the previous night.

'You said it wasn't his heart' screamed his wife at Amber, (which she hadn't, but you can understand the grief) while Amber had tears streaming down her face.

The man dies.

As an agency nurse, Amber didn't get support from management, so we discussed what to do. She decided to photocopy her notes, as well the ECG from the previous night.

She's called into a meeting with management the following day, and I go as her support person, and we're sitting in an office, and we hear the head doctor approaching with a bunch of big-wigs from the hospital, and we clearly hear him say 'she's done for, she messed up.'

Amber confronts him on this, and he doesn't have a reply, but they accuse her of not doing her job, and say the man did not get an ECG. We all go through the notes together and the ECG is missing. She tells them she did do one, and the doctor signed it, and gave his name, but they don't believe her.

'Well it's just as well I have a copy then don't I' she says, producing the copy of the ECG.

This action saved her. Saved her career, and saved her from a witch hunt.

She eventually was cleared of any wrong doing, although management were never confronted about the missing ECG, which would have helped them find someone to blame.

Anyway, that's one of the agency experiences that has taught me not to trust anyone.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Thank you for sharing this story.

A nightmare, indeed, that was averted by a piece of paper.

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Isn't keeping copies of such things on your person considered a breach of HIPAA?

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Isn't keeping copies of such things on your person considered a breach of HIPAA?

yes it broke some rules, but I'm glad she did it. We were both hardened by temp nursing and knew to trust no one and protect ourselves.

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From the information in your post it appears as though the patient, who was complaining of what appeared to be cardiac related chest pain, was, until the time they left the A&E after being there for two hours, given a single EKG (you don't say if it was a 12 lead EKG) which apparently did not show changes indicative of ACS or another serious arrhythmia, and was not put on a cardiac monitor and continuously monitored over a period of time. You did not mention vital signs and pulse oximetry being recorded, or whether oxygen was given, or whether an IV was started. From the information given, my thought is that an MI or serious arrhythmia may have been missed, as the following night the patient arrived at the facility in cardiac arrest.

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Specializes in Registered Nurse.

It's difficult for me to think about being targeted to take the fall like that, but I am sure it does happen. I am just going back into hospital work. I wonder if EKGs are scanned up into the computer now. I guess I'll find out. Anybody work in a hospital that scans up EKGs and other testing copies now?

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From the information in your post it appears as though the patient, who was complaining of what appeared to be cardiac related chest pain, was, until the time they left the A&E after being there for two hours, given a single EKG (you don't say if it was a 12 lead EKG) which apparently did not show changes indicative of ACS or another serious arrhythmia, and was not put on a cardiac monitor and continuously monitored over a period of time. You did not mention vital signs and pulse oximetry being recorded, or whether oxygen was given, or whether an IV was started. From the information given, my thought is that an MI or serious arrhythmia may have been missed, as the following night the patient arrived at the facility in cardiac arrest.

As far as I ca remember obs all fine. As part of taking bloods I've line inserted but nothing given. Was a 12 lead ECG. The assessment unit is not for monitored patients, but to decide if needs to be seen sooner. With hx and bloods plus ECG given to doctor he decides whether they can wait. So as he felt not sounding cardiac and patient in no pain or distress was simply waiting.

I am surprised you think this cardiac and even more surprised you think arrhythmi as everything points to muscular/skeletal and the doctor thought so as we'll.

regardless the doctor made. The call not the nurse.

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As far as I ca remember obs all fine. As part of taking bloods I've line inserted but nothing given. Was a 12 lead ECG. The assessment unit is not for monitored patients, but to decide if needs to be seen sooner. With hx and bloods plus ECG given to doctor he decides whether they can wait. So as he felt not sounding cardiac and patient in no pain or distress was simply waiting.

I am surprised you think this cardiac and even more surprised you think arrhythmi as everything points to muscular/skeletal and the doctor thought so as we'll.

regardless the doctor made. The call not the nurse.

The patient was male, 50 years old, African, had started a weight training program the day before (these are risk factors for cardiac related chest pain), and presented with left and right sided chest pain. It is appropriate to rule out cardiac causes as a priority, although there could of course be other causes of the chest pain.

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1. It's not my worst nightmare since I don't diagnose patients.

2. Whether or not the patient signed the form, he left AMA.

3. I have good . Recommend for anyone, especially agency nurses. Goes a long way towards peace of mind and not worrying about highly unlikely "what ifs"

I am guessing this scenario happened in the 90's like the previous story from this hospital? The relevance to modern nursing escapes me.

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If this really occurred, it wouldn't be in the US and wouldn't be recent. You'd never get away with having a copy of a patient chart here, because even if it exonerated you, you'd get slammed for violating HIPAA. This poster may have a future in popular writing of the Parade-Reader's Digest variety, though. Try peddling it there, eh?

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If this really occurred, it wouldn't be in the US and wouldn't be recent. You'd never get away with having a copy of a patient chart here, because even if it exonerated you, you'd get slammed for violating HIPAA. This poster may have a future in popular writing of the Parade-Reader's Digest variety, though. Try peddling it there, eh?

2005, and I don't have the imagination to make something like this up.

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Specializes in Complex pedi to LTC/SA & now a manager.
Isn't keeping copies of such things on your person considered a breach of HIPAA?

HIPAA is unique to the U.S. This apparently was in the UK hence A&E (accident & emergency) instead of ER/ED. I'm sure privacy laws still apply but a bit different with socialized medicine and ten years ago.

I couldn't make copies of a patient chart for my own records in good consciousness. I would maintain professional though to ensure I had professional representation rather than a colleague.

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