Nursing and Principles of Protecting Patient Safety - Case Study Example

 Table of Contents I. Principles of Protecting Patient Safety Involved in Case 3 II. On whether the nurses were negligent for delaying medication documentation 3 III. On whether the delay was below the standard of care 3 IV. Ethical Principles for Consideration When Hospital Looks at Situation Root Causes 4 V. Charges if the Case Were to Go to Trial, Kind of Court to Hear the Case 4 II. Defendants, Plaintiffs 4 II. On How the Court is to Rule on the Case 5 III. On Whether to Involve the Nursing State Board or Not, and Why 5 IV. On Whether the Policy and Procedures Manual of the Hospital Should be Altered/Changed or Not, and Why. Involved Parties In Case Changes Are to be Made 6 V. Answers to End of Case Questions 6 References 8 I. Principles of Protecting Patient Safety Involved in Case The proper administration of narcotics to patients is an aspect of patient safety relating to procedures as well as to the accuracy of the doses given to patients. Timeliness of administration is also an issue, where for instance the procedural changes can affect the timeliness and availability of the medications when they are needed. Errors are to be expected in complex setting such as acute care, but they have to be addressed systematically to improve patient safety and outcomes (Brindley, 2010). II. On whether the nurses were negligent for delaying medication documentation There were practical reasons that the nurses cited to break with procedures and delay the documentation for the medication. First the nurses would electronically sign off on IV bags, for instance, so that they would be available when they were needed, even though they had to be junked sometimes when the situation for their need ceased to be operative, or the doctors changed their minds. There was no procedure in place also to make sure that nurses remembered what they signed for electronically, as they did this at the end of the shift or during their breaks. The redundant electronic and manual entries were procedural elements that led to lapses due to human errors that are understandable given the situation. No, the nurses are not negligent. The procedure is flawed (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.) III. On whether the delay was below the standard of care It is not below the standard of care to delay the documentation for the documentation, given that this has to take a lower priority in a list of priorities that include spending time with more critical patient-related tasks, such as administering the medications, doing the rounds, and assisting the doctors with patient-related needs. This is an error in procedure that the nurses were made to go into, and which led to understandable lapses (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.). IV. Ethical Principles for Consideration When Hospital Looks at Situation Root Causes The primary consideration is intent. Do the nurses have an intent to cheat procedures in order to gain personally, and to compromise patient safety and outcomes? Is the intent criminal, or are the mistakes and lapses understandable consequences of nurses making mistakes due to flaws in procedures themselves? Are the nurses working in earnest, rather than intentionally cheating in order to gain access to narcotics for their own use? (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.) V. Charges if the Case Were to Go to Trial, Kind of Court to Hear the Case The charges the hospital may level against the nurse would be intentional breach of procedure in order to procure narcotics and cheat the hospital, and criminal intent to compromise patient safety by compromising supplies of vital narcotics, among many other potential cases. A labor court, or a criminal court, can hear this case (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.) II. Defendants, Plaintiffs If the case were to go to trial, there would be the given that the arbitrator had ruled in favor of the nurse who was suspended. That nurse in question had filed a grievance. The hospital had appealed the decision of the arbitrator, and would sue. The plaintiffs in a case, if this were to go to trial, would be the hospital administrators, on behalf of the hospital. The defendant would be the nurse who was initially suspended. The case would then be built on these case facts, with the decision of the arbitrator and the ensuing appeal filed by the hospital, together with the evidence presented in the trial tied to the appeal, as being the givens of the case (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.) II. On How the Court is to Rule on the Case If this case were to go to trial, given the evidence presented in the case facts, the court would rule in favor of the defendant, and the hospital charges would be junked. This is because it is clear from the evidence that there was no intention to cheat the hospital. The error lay in the procedures, that made the nurses prone to commit errors in the manual documentation (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.). III. On Whether to Involve the Nursing State Board or Not, and Why Certainly a case can be made for involving the state nursing board in this case, because the nurse’s rights may be compromised, and if the trial goes in favor of the hospital, then the rights of other nurses may also be compromised. This is because the problem is with procedure. The same procedure of having to do manual documentation for medications can lead to other nurses making the same lapses, and can lead to the hospital charging them for similar crimes (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.) IV. On Whether the Policy and Procedures Manual of the Hospital Should be Altered/Changed or Not, and Why. Involved Parties In Case Changes Are to be Made The procedures relating to the manual documentation of medications should be changed. The manual and electronic systems have to be integrated, and should have facilities for returning items that were not used due to various reasons, such as change of circumstances and change of mind on the part of the doctor. The hospital admin and the nurses should be involved when making changes, because the nurses for one have intimate knowledge of the process and its current flaws (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.). V. Answers to End of Case Questions 1. The facility did not seem to have ample evidence to enforce the suspension of the nurse from her work. This is due to the fact that they took the procedure as fool-proof and error-proof, and there were the testimonies of the nurses that showed the flaws in the procedures (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.) 2. The testimonies of the other nurses clearly show that the procedures are full of holes, and that the manual documentation procedure, when considered in the context of the work flow of the nurses, is prone to error. These testimonies are material, and have deciding impact on the case (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.) 3. Additional questions: Do other nurses show the same discrepancies in their manual documentations, or is this an isolated case? Did they pursue similar cases if there were discrepancies with other nurses, or are they solely prosecuting the nurse in this case? (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.) 4. I would rule in favor of the nurse, and junk the case filed by the hospital, for the reasons already cited in the above discussion (Brindley, 2010; WHO, 2002; AMA, 2013; Jones, n.d.) References AMA (2013). New AMA Report Offers Principles for Patient Safety After Hospital Stays. AMA. Retrieved from http://www.ama-assn.org/ama/pub/news/news/2013-02-06-principles-patient-safety-after-hospital-stays.page Brindley, P. (2010). Patient safety and acute care medicine: lessons for the future, insights from the past. Critical Care. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887110/ Jones, K. (n.d.). An Introduction to Patient Safety Principles for Rural Healthcare Providers and Governing Boards. University of Nebraska Medical Center. Retrieved from http://www.unmc.edu/rural/patient-safety/presentations/Intro%20to%20Patient%20Safety%20Principles%20for%20Boards%20revised%20final.pdf WHO (2002). Quality of care: patient safety. WHO. Retrieved from http://www.who.int/patientsafety/worldalliance/ea5513.pdf Read More