Ethical Dilemma in Surgical Event - Essay Example

Ethical Dilemma in Surgical Event The increasing accountability placed on every health personnel defends their rights as professionals and protects the overall well being of patients placed in their hands. Yet, errors are still evident. A definite violation in ethical responsibility is executed when the autonomy of patients, manifested with signing of informed consent, is being disregarded, while the duty to do good is breached with such error, increasing health risks when some procedural details had been overlooked. An example of such event is the ambulatory surgery in Same Day Surgery at Veteran Hospital in Jackson, Mississippi. A client had been registered for an elective surgery under local anesthesia, so the client can drive home after the local anesthetic wears off. In clinical standard, a consent for surgery had been secured, where it was clearly indicated that the client is to receive local anesthesia only by the nurse anesthetist. During intra-operative period, a mixed-up occurred, where monitored anesthesia had been administered, instead of local one. Expecting the latter, the client came to the hospital alone through his own vehicle. In institutional policy, clients should be admitted for at least a day as part of post-anesthesia monitoring if they received monitored anesthesia. Post-operatively, the client was not admitted, and had no one to drive for him home. A nurse became aware of inconsistency with type of anesthesia indicated in consent form from the inducted one. The surgical team and nurse manager were informed of such mistakes, and the event was duly documented. Despite hospital protocols, the physician refused admittance for an outpatient procedure, leaving receiving nurses with no option but to look for a driver to bring the said client home. Clearly, a number of clinical and ethical discrepancies can be observed. For one, the anesthesia indicated in the consent form had not been followed during actual surgery, giving undue risk to client who had no companion to drive him home during monitored anesthesia care. Another thing is the adamant refusal of the physician to admit the client overnight, despite the institutional policy to do so with such anesthetic category. Lastly, giving the burden of managing the aftermath of the error to nurse, conflicts the organizational accountability that all members of surgical team are obligated to resolve existing discrepancies during and after clinical service delivery. The breach in consent form could have been prevented according to benchmarks indicated for surgical safety. A known surgical checklist divides the universal protocol in three sections: “sign-in, time-out, (and) sign-out.” In all parts, every opportunity is given to review pertinent things, from preparation of equipments, to detailed data in consent form, and relevant information on correct patient, surgical site, and procedure. Unfortunately, time-out process was disregarded, where the pause indicated to ascertain whether pre-operative details are followed and concerns with actual operation are addressed had been foregone (“Theatre,” 2008). Through this, induction of wrong anesthetic technique, then, could have been avoided. The ethical parameters in consent form were neglected. More than legal safeguard, this represents professional respect for clients’ autonomic right to participate with clinical decision-making process. As emphasized by White and Baldwin (2003, p.762), informed consent should be specifically denote the “anesthetic techniques...which had been discussed and agreed by the patient.” As observed in the situation, patient autonomy is breached with the procedural error, and ethical dilemma begins. This is even compounded by refusal of providing physician to admit the patient. The danger of monitored anesthesia induction ranges from respiratory depression to neurological dysfunction resulting to trauma (Bhananker, Posner, Cheney, Caplan, Lee, & Domino, 2006). As such, the practitioner is fully aware of client’s medical risk when not admitted for close monitoring, yet had still refused hospital admittance. As patient advocate, he should have admitted the client, despite the brevity of outpatient procedure. At large, he violated the ethical principle of doing no harm by disregarding hospital regulations. However, the nursing team resolved this by looking for someone to drive for client. Although this was out of nursing bounds, nursing care must always be patient-centered, despite organizational liability to do otherwise. The physician may deemed the client neurologically sound and thought he was not legally and ethically bound for post-operative services, but the clinical manager felt it was their duty to protect the client’s safety above other institutional factors. The breach on anesthetic detail, lack of professional harmony, and organizational risks with such cover-up attempts by nursing staff may imply nonconstructive impacts on standard risk management concepts. Maity (2006) described risk management as means in which adverse events are determined, and further examined, where investigation outcomes can be utilized to prevent future episodes of system and human discrepancies. On the former, organizational protocols are deemed lacking in assuring patient safety, while the latter comprise errors and violations in abiding by available hospital regulations. The professional values and attitude maintained by several health professionals seemed to at fault, since institutional policies dictated patient admittance with surgeries needing extensive anesthetic monitoring, excluding local category. Maity (2006, p.96) added that actual risk process includes early determination of system or individual failures, “prompt incident reporting...early warning of possible claims...(and) early and structured investigation.” Although the physician had been warned of errors, the refusal to remedy them compounds the problem of protocol breach, while cover-up attempts were temporary in resolving the problem of consent violation, and subsequent mishandling with client’s lack of escort to home. These areas of concern need to be reviewed before further administrative are initiated. In resolution, it is better for health personnel to be extensively guided by ethical decision-making process through integrative model. As posited by Balcazar, Suarez-Balcazar, Taylor-Ritzler, and Keys (2009), health professionals deal with ethical dilemmas in four steps: objectively examining the sections for possible discrepancies, investigate such situation using standard principles and institutional policies, analyzing the multiple issues in accordance with personal values and sociocultural perspectives, and lastly, discrete and valid decisions are developed according to competing concepts in former procedural steps. As such, health care professionals need to take into account existing hospital regulations, together with their own values rendered as professionals before deciding the right course of action. It may sound confusing, but when such health team formulated their professional values according to existing ethical standards, in patient centered way, health personnel will have little difficulty in performing their duties with minimal safety risks. References Balcazar, F.E., Suarez-Balcazar, Y., Taylor-Ritzler, T., & Keys, C.B. (2009). Race, culture, and disability. United States of America: Jones and Barlett Publishers. Bhananker, S.M., Posner, K.L., Cheney, F.W., Caplan, R.A., Lee, L.A., & Domino, K.B. (2006). Injury and liability associated with monitored anesthesia care: A closed claim analysis. Anesthesia, 104, 228-234. Maity, C. (2006). Medical interviews and professional development: the essential handbook for the junior doctor (2nd ed.). United Kingdom: Radcliffe Publishing. Theatre checklist and patient safety. (2008). Anesthesia, 63, 921-923. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2008.05642.x/pdf White, S.M., & Baldwin, T.J. (2003). Consent for anesthesia. Anesthesia, 58, 760-774. Retrieved from http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.2003.03202.x/pdf> Read More