In past blogs, I have discussed the importance of adhering to standards of care and how severe the consequences can be if this isn’t done. Among some of the topics I’ve addressed are the failure to report major changes in a patient’s condition and the necessity of accurate documentation in a patient’s medical record in whatever form.
I have also stressed how not adhering to the standards of care can result in liability for your facility. The following case is another great example of how important it is for nursing staff to maintain their standards of care.
Particulars of the Case
A female patient arrived at a facility’s emergency room with chest tightness, cough, fever, sinus trouble, and a headache. A physician diagnosed the patient with acute coronary syndrome and ordered a therapeutic dose of an anticoagulant blood thinner. The next day, his diagnosis was changed to “hypertensive emergency” without acute coronary syndrome.
The doctor intended to change the therapeutic dose of the anticoagulant blood thinner to a prophylactic dose and documented this in his progress notes. But he did not create a separate physician’s order to change the dosing (the facility didn’t have a policy about physicians documenting such a change separately).
On the third day of the patient’s hospitalization, the physician documented that the patient was constipated and had abdominal discomfort. The physician planned to order an abdominal CT scan and brain MRI. On the fourth day, the patient’s blood pressure was low and two small hematomas were detected in the abdomen. No further anticoagulant medication was given.
The patient suffered an acute and severe hemorrhage on the fifth day and was transferred to the ICU. She was treated with repeated blood transfusions and placed on a ventilator, among other medical interventions, but she died in the hospital two weeks later.
Patient’s Husband Files Wrongful Death Case
The patient’s husband filed a lawsuit against the physician and the healthcare facility. The husband alleged that the healthcare facility’s nursing staff:
- Failed to properly evaluate his wife
- Failed to properly interpret diagnostic data about his wife’s condition
- Failed to recognize signs and symptoms of hematoma, renal failure, and a life-threatening bleed
- Failed to properly report the vital clinical and laboratory results to the physician in a timely manner
- Failed to decrease or discontinue administration of therapeutic anticoagulant medication following the physician’s order
The husband also asserted that the continued administration of the anticoagulant caused his wife’s death.
The husband supported his allegations by filing an expert report from a physician who stated how the allegations listed by the husband breached the standards of care for the nursing staff and physician.
For the purposes of this blog, the breached standards of care for the nursing staff include:
- Not monitoring the patient’s chart for orders and continued care
- Continuing to administer life-threatening anticoagulants for two days contrary to the physician’s documented plan of care and when not indicated by the patient’s condition
- Not communicating changes in the patient’s condition to the physician, including her low blood pressure, in a timely manner
The expert also stated that the therapeutic …read more
Read full article here: nurse.com
