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Old 04-10-2011, 09:05 AM
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Default Professional Negligence and Nurses

Case Study:

A 38-year-old woman undergoes an operative laparoscopy for pelvic pain, dysmenorrhea, and infertility.
During the operation the surgeon perforates the inferior vena cava (This is a known risk for this procedure and the perforation alone does not constitute negligence)
The surgeon notes "some blood" in the abdomen suctioned during the procedure, but fails to investigate the cause.
The patient was taken to the PACU at 1040 following surgery. The receiving PACU nurse noted vitals to be B/P 138/68 P 135 the cardiac monitor indicated sinus tachycardia R 28. The PACU nurse discussed these finding with both the surgeon and the anesthesiologist, neither of them were concerned. Vital signs were to be done Q15min. The patients B/P showed a consistent drop with a consistenly elevated pulse. The last documented B/P was at 1105 with a reading of 105/60. 1120 the only documented VS is a pulse of 138. At 1125 the patient is discharged from the PACU to the Same Day Surgery (SDS). At 1200 the patient is admitted to SDS( no one knows what was happening from 1125 to 1200 there is no documentation). Admission assessment notes the patient is alert with B/P 105/60 P 138 T 96.7 R 20. The PACU nurse informs the SDS nurse the physician is aware of the patients elevated pulse. At 135 the nurse documents that the patient was sleeping with bandages intact. At 235 the patient was found unresponsive, pale, and not breathing. A code was called, but the patient was unable to be resucitated and was pronounced dead at 335.
The autopsy report stated the cause of death was "acute internal hemorrhage due to perforation of the inferior vena cava during a laparoscopic procedure"

Who was found to be liable for negligence?

In this case the surgeon and the both the PACU Nurse and SDS Nurse shared liability. The surgeon deviated from the SOC by failing to investigate the source of blood loss and not following up with tests related to the patients VS following the surgery.
The PACU and SDS Nurses were found to have failed to properly monitor and document monitoring of the patient as well as recognize and report signs and symptoms of acute blood loss. Taking one physicians "I'm not concerned" attitude as a basis for a patients well being is not acceptable. You are a nurse, not an appendage to a physician.

http://responsiblenurse.com/Casestudies.aspx
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Old 04-10-2011, 09:25 AM
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Scary thing to have happened but as a nurse 101 for hemorrhage is elevated HR, RR and dropping BP. Apart from all that went on I would have continued pushing the issue with a patient that had elevated HR and dropping BP with any doctor I could get to listen to me and document it ALL as I go!!!
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Old 04-10-2011, 03:17 PM
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See now my surgeries we are expected to have HRs that high because of the manipulation of the aorta. I always tell MD and document. I will continue to monitor and document as I go, but many of my MDs and PAs it falls on deafs ears sometimes...however, if need be i would get management or higher ups involved.

I am also not waiting from 12 to 235 before checking on my patient again either. I am checking my patients quite frequently.
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Old 04-11-2011, 01:27 PM
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If the increased heart rate from manipulation of the aorta is a finding of its own, and not one that goes along with decreasing B/P and increasing RR, I would be nagging the living hell out of everyone about it (while documenting the nagging and the responses to it). I'd also check on the temperature of the hands and feet while I was at it, in light of those signs.
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Old 04-11-2011, 03:37 PM
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I question why the anesthesiologst was not held liable. They are directly responsible for the monitoring of the patient during surgery and in the PACU. The anesthesiologist should have known what those vital signs meant and would be the only one to differentiate between VS results from hemorrhage, meds/drugs and anticpitated post surgical.
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Old 11-22-2011, 11:06 PM
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Great case study! As health care providers, we must be aware of the legal aspects concerning our profession. This is not only to protect our license but rather to be effective and efficient in rendering care to our patients.

Exhibited above was the case of a woman who underwent operative laparoscopy, conscious and coherent before the procedure, but died hours post operation. What went wrong? The inferior vena cava perforation is a known risk therefore, the perforation alone was not considered a professional negligence or medical malpractice. Take note that the majority of issues similar to known potential risks usually are not considered malpractice. Better check this article written by Mr. Haskell for additional information about medical malpractice. Here it is: Medical Mistakes -- A Primer on the Basics of Medical Malpractice.

Moreover, with regard to the manifestation of blood in the abdomen intraoperatively, the surgeon should not have ignored it. The medical practitioner should have intervened at once to halt the bleeding.

On the part of the nurses, they failed to monitor the client's condition post operatively. The documentation was not accurate and proper referral was not done PERSISTENTLY. If the VS were deteriorating, then they should have persistently refer it . If the physician ignored their referral, then they should have documented it. Another is, the nurses should have consulted the charge or head nurse about the medical practitioner's ignoring behavior.

To conclude, health care professionals, may it be physicians, nurses or other healthcare team members must be PATIENT-CENTERED. Any health provider must be aware of that. PATIENT'S SAFETY is our priority, and so we should NEVER compromise their well-being because of negligence (either through commission or omission). Bear this in mind, the saying, "to err is human, to forgive is divine" is not applicable in the medical field. Albeit it is applied generally, forgiving or ignoring healthcare errors in medicine is not acceptable. So let us do our job effectively; our profession's goal is to render care and not to place more injuries or worst kill our patients.
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Old 11-23-2011, 02:59 PM
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Thank You for the link Haley and welcome to Just Us Nurses
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Old 11-23-2011, 04:33 PM
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Quote:
Originally Posted by DutchgirlRN View Post
Thank You for the link Haley and welcome to Just Us Nurses
Ditto
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