Negligence in Documentation - Essay Example

? Negligence Given a definite scenario, the aims of the essay are to address the following concerns to differentiate between negligence, gross negligence, and malpractice. Based on the information, decide if one agrees with the statement in given scenario; (2) to describe the importance of documentation (relating to the given simulation) and its correlation to potential negligence. Specifically, the following questions would be answered: (a) if you were the nurse in this situation, what ethical principles would guide your practice? And (b) how would you document the case to satisfy ethical and legal requirements? Negligence Background based on the Scenario The facts from the given scenario indicate the case of a 62 year old, diabetic patient, Joseph Benson, who supposedly underwent an amputation of his leg just below the left knee. The impending dilemma and major complication is that the wrong leg was amputated. The hospital identified to be the scenario of the event was likewise concurrently experiencing problems with the union and a shortage in staff, particularly nurses. In this regard, the aims of the essay are to address the following concerns: (1) to differentiate between negligence, gross negligence, and malpractice. Based on the information, decide if one agrees with the statement in given scenario; (2) to describe the importance of documentation (relating to the given simulation) and its correlation to potential negligence. Specifically, the following questions would be answered: (a) if you were the nurse in this situation, what ethical principles would guide your practice? And (b) how would you document the case to satisfy ethical and legal requirements? Differentiation between Negligence, Gross Negligence and Malpractice According to Delaune and Ladner (2006), negligence is “the failure of an individual to provide care that a reasonable person would ordinarily use in a similar circumstance. In other words, action that is contrary to the conduct of a reasonable person and results in harm is considered to be negligent behavior. When a nurse commits a negligent act that results in injury, it is known as malpractice” (201). To differentiate the terms to gross negligence, Thorton (2006) averred that it “is a much more nebulous and complicated concept. Gross negligence is an act or omission ‘which (1) when viewed objectively from the standpoint of the actor at the time of its occurrence involves an extreme degree of risk, considering the probability and magnitude of the potential harm to others; and (2) of which the actor has actual, subjective awareness of the risk involved, but nevertheless proceeds with conscious indifference to the rights, safety, or welfare of others’” (cited from Tex. Civ. Prac. & Rem. Code, Section 41.001 (11), Vernon's 2006 by Thorton, par. 6). More clearly, malpractice is defined by Stubenrauch (2007) as “improper or unethical conduct or unreasonable lack of skill by a holder of a professional or official position; often applied to physicians, dentists, lawyers, and public officers to denote negligent or unskillful performance of duties when professional skills are obligatory” (cited from The Joint Commission by Stubenrauch, 2007, par. 1). In the given scenario, the act of the responsible health care practitioner appears to be categorized as gross negligence because of the presence of the elements of omission resulting in extreme degree of risk and harm to the patient. Importance of Documentation According to Stimpfel (2007), “quality medical charting is important in providing high quality care and also because in the current health-care system, a number of patients who believe they have sustained physical or psychological harm as a result of their healthcare provider’s negligence bring claims or lawsuits to recover damages” (1). The lack of proper documentation and accurate identification of the leg to be amputated in the patient chart resulted in gross negligence that contributed to bodily injury, potential emotional and psychological damage to the patient, in the long run. The symptoms that were contributory to this is the lack of nurses in the hospital. It could be surmised that due to the number of patients that need to be attended by a minimum number of nurses, the appropriate nurse to patient ratio was not duly followed and adhered to. As a result, regular updates, proper identification, complete narrative discourse on the patient information led to the wrongful amputation of the leg. Further, other standard procedures were omitted by both the nurses on duty and the surgeon in terms of confirming, with either the patient or the relatives present, prior to the surgery, to identify and mark the correct leg prior to the procedure. (a) If you were the nurse in this situation, what ethical principles would guide your practice? Nurses are bound by ethical principles of respect for autonomy, nonmaleficence, beneficience, justice, veracity, confidentiality, and fidelity (Delaune and Ladner, 2006, 214 – 216). For this scenario, the relevant ethical principles that should guide one’s practice are the principles of nonmaleficence (duty to cause no harm to others) and beneficience (the duty to promote good and to prevent harm) and also the principle of veracity (truthfulness). Despite the lack of nurses in the hospital, there is no acceptable reason on the part of the health care practitioners who attended to Benson that could justify the harm inflicted on him. It is the nurse’s obligation, first and foremost, to have correctly and accurately identified the leg to be amputated in the patient’s chart and marked, verified and confirmed accordingly prior to the surgery. The ethical principle of nonmaleficence and beneficience should have provided guidance to ensure that good is promoted and that harm is not at all inflicted to the patient – who was seeking improvement and relief in his health status, instead of harm and injury. As emphasized by Delaune and Ladner (2006), “nonmaleficence is considered a fundamental duty of health care providers… (where) providers are to cause no harm to clients” (214). The acts of omission were tantamount to gross negligence that resulted in the wrong leg being amputated: a much preventable event only if due care in the implementation of duties and responsibilities are properly undertaken, as needed and dictated by these ethical principles. (b) How would you document the case to satisfy ethical and legal requirements? The Joint Commission provides guidelines specifically for the “prevention of wrong site, wrong procedure and wrong person surgery by focusing on the following: (1) undertake a pre-operative verification process; (2) marking the operative site; (3) noting crucial exemptions; and (4) practicing “time-out” immediately before starting the procedure (American Academy of Orthopedic Surgeons (AAOS), 2011). Nurses could prevent the outcome of the scenario for Benson, a wrong site surgical procedure through following the abovementioned process. The pre-operative verification process aims to identify, mark and accurately validate the exact site, correct procedure and the identity of the patient while the patient and the relatives are awake, prior to the operation or surgery. As enumerated in the AAOS discourse, “a standardized preoperative verification checklist may be helpful to ensure availability and review of the following, prior to the start of the procedure: relevant documentation (e.g., H&P, consent); relevant images, properly labeled and displayed; and any required implants and special equipment” (AAOS, 2011, par. 3). Marking the site to be operated on would ensure that the accurate site is identified, verified and appropriately validated. Some recommendations from AAOS are cited as: The marking should be made by an individual that is familiar with the patient and is involved with the patient’s procedure. This individual is encouraged to be the surgeon or (1) individuals permitted through a residency program to participate in the procedure (2) a licensed individual who performs duties in collaboration with the surgeon i.e. nurse practitioners and physician assistants. Marking should take place with the patient involved, awake and aware, if possible. Final verification of the site mark should take place during the "time out." (AAOS, 2011, pars. 10 – 12). Finally, the “time-out” procedure is a must is recommended to “be conducted in the OR/procedure room before the procedure/incision. It should involve the entire operative team, use active communication, be briefly documented, such as in a checklist (organization should determine the type and amount of documentation) and should include: correct patient identity; correct side and site; and agreement on the procedure to be do” (AAOS, 2011, par.18). All of these measures would ensure that any form of negligence, gross negligence or malpractice is prevented in the future. References American Academy of Orthopedic Surgeons (AAOS). (2011). Joint Commission (JC) Guidelines. Retrieved 10 April 2011. < http://www3.aaos.org/member/safety/guidelines.cfm> Delaune, S.C. and Ladner, P.K. (2006). Fundamentals of Nursing: Standards and Practice. Thomson Delmar Learning, USA. Stimpfel, N. (2007). “Quality Medical Charts: The Importance of Proper Medical Record Documentation.” TranforMed Research, pp. 1 – 2. Stubenrauch, J.B. (2007). “Malpractice vs. Negligence.” AJN, American Journal of Nursing, Volume 107 Number 7, Pages 63 – 63. Tex. Civ. Prac. & Rem. Code, Section 41.001 (11), (Vernon's 2006). Malice/Gross Negligence. Retrieved 10 April 2011. < http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1618741/> Thorton, R.G. (2006). “Malice/gross negligence.” Proceedings (Baylor University Med Cent), 19(4): 417–418. Read More