If you work in a healthcare facility, such as a hospital or a nursing home, you know all too well that one of your important obligations is to inform the patient’s physician or advanced practice registered nurse (APRN) when the patient’s condition changes.
In his article, Malpractice Risks of Health Care Communication Failures, Jock Hoffman states that one-third of medical malpractice cases can be directly tied to communication breakdowns.
In the following unpublished case, a communication breakdown is outlined wherein a nurse’s failure to report to the physician a major change in her patient’s condition is said to have caused the patient’s death. A wrongful death lawsuit soon follows.
Details of the Case
The 62-year-old female patient had a history of abdominal surgeries, including gastric bypass surgery. The surgeries resulted in “excessive” scar tissue.
She went to the ED complaining of abdominal pain and vomiting that began the day before. The patient’s lungs were clear, but due to her symptoms, she was admitted for IV fluids to rehydrate her. Treatment for pain and nausea also was administered.
The patient was in the hospital for a few days, and a doctor diagnosed her with constipation. She was placed on “bowel rest” by limiting the amount of food she could eat. No surgery was indicated, according to the physician.
Two days after her admission, nursing notes indicated that the patient was “spitting up into emesis bag” and had “dry heaves.” She was examined again by another physician who determined she was still constipated but was breathing “normally.” The second physician was concerned, however, that the patient should be transferred and seen by the surgeon who did the gastric bypass surgery. She was to be transferred the next morning.
That night, the patient vomited numerous times during the night shift. The RN caring for her documented in the patient’s medical record that the patient expressed a feeling like a “knot in [her] abdom[e]n” but her pain was decreased from earlier in the day.
The patient also was nauseous, had a small emesis, and a bowel movement.
The nurse did not observe any signs of aspiration, documenting that the patient’s lungs were clear. Later that night, the RN documented that the patient had another emesis, “small, tan-colored…with a faint bowel odor throughout the night.” The RN did not contact a doctor about these events.
When the patient was transferred in the morning, the RN’s documentation indicated the patient was stable and her condition “did not seem to have deteriorated” since she began her care the night before.
The patient was transferred and arrived at the second hospital “looking comfortable, not in distress” according to her physician’s admitting note. However, the patient’s condition soon changed.
The white-blood-cell count was low, a CAT scan showed a bowel obstruction and evidence of pneumonia in sections of her lungs, despite no symptoms of pneumonia. Antibiotics to treat the pneumonia were immediately administered, but the patient’s condition continued to worsen. She died the following day. The autopsy listed the patient’s death as “pneumonia as a result …read more
Read full article here: nurse.com
