Discuss the following:
Topic 1: The Legal Implications of Acceptance or Refusal.? After reviewing the ANA position statement on "Rights of Registered Nurses when Considering a Patient Assignment," discuss the legal and ethical implications of accepting assignments. When delegating assignments to unlicensed personnel, what considerations need to be considered? What insurance issues come into play? Analyze the legal principle of Respondeat Superior.
Topic 2: Defenses to Malpractice and Risk Management. Take the malpractice case assigned to your group and discuss the defenses that may be raised in that case. Discuss how the incident could have been prevented. What risk management techniques could have been used before and after the adverse patient occurrence? Respond to the other case scenario.
Yolanda Pinnelas case study is an exemplification of malpractices that nurses face, most of which are preventable. As Buppert (2017) notes, nursing standards of care provide a framework by which nurses practice nurses to ensure competence and prevent ethical and legal violations. Standards of care in nursing are found in different sources, including nursing practice act, nursing board declaration statements, journals and other forms of credible researches, textbooks and nursing education among others. Often, they are usually very basic and general, applicable across settings and adjusted to make them specific to specialty, at time. In the case of Pinnelas, malpractices can be seen due to failure to comply with nursing standards of care in reference to poor insertion of IV tube and failure to monitor patient when giving the IV chemo drug by the nurse in charge leading to failure to notice the wrong insertion (leaking IV fluids to nearby tissues). This also goes for poor collaboration skills among nurses and communication of critical patient care information by nurses who had the Beep alert from IV pump but never bothered to check and/or inform the nurse/physician in charge. All these events lead to surgery and her losing the functionality of her hand meaning that she will never get to practice her career as a music conductor.
The Nursing Practice Act-NPA stipulate legal standard of care that nurse must employ to decrease legal issues that may emerge. This implies doing what reasonable nurse under similar practice and offering care to a similar patient may do. When applying NPA, focus would be evaluating whether the nurses have complied with nursing standards of care as under the Act. This is in reference to negligence of patient rights and needs (constant monitoring), inability to practice while being reasonable of safety of patients, and knowingly violating provisions/rules of board of nursing in relation to patient care. Due to these violations, the Act allows for disciplinary actions against the nurses, including denying them renewal of licenses, suspending, denying and revoking license (Buppert, 2017).
While assessing the nurses involved in the care of patient in reference to whether they meet standards of practice, the court will assess nurse compliance to proper protocols and expectations of nurses in provision of quality and safe care. There may be a tendency of the nurses to pin the lack of standards of care to the hospital due to the high nurse-patient ratio, leading to overworking and fatigue with the hope that the hospital with be veraciously liable, as indicated under respondent superior doctrine. This may happen, as a hospital is also responsible for ensuring nursing standards of care are maintained, thus responsible for ensuring there are sufficient nurses needed to maintain the quality of care provided all the time- injuries emerging from nurse shortage may pose a liability to the hospital (Buppert, 2017). Nonetheless, this may mostly happen if the employee was acting as per nursing professional care standards and within the expected scope when the malpractice occurred (American Nurses Association, 2015). However, if the nurse still acted against the standards of care, either through omission or on negligence basis, the nurse will still be liable for violation of standards. In this case study, despite the nurses being busy, they failed to comply with basing nursing standards of care by failing to monitor the patient and communicate effectively in the shared patient care responsibility to ensure patient safety.
Case Study: Malpractice Action Brought by Yolanda Pinnelas
People involved in case:
Yolanda Pinnelas - patient
Betty DePalma, RN, MS - nursing supervisor
Elizabeth Adelman, RN - recovery room nurse
William Brady, M.D. - plastic surgeon
Mary Jones, RN - IV insertion
Carol Price, LPN
Jeffery Chambers, RN - staff nurse
Patricia Peters, PharmD - pharmacy
Diana Smith, RN
Susan Post, JD - risk manager
Amy Green - quality assurance
Michael Parks, RN, MS, CNS - education coordinator
SAFE-INFUSE - pump
Brand X infusion - pump
Caring Memorial Hospital
Facts:
The patient, Yolanda Pinellas, is a 21-year-old female admitted to Caring Memorial Hospital for chemotherapy. Caring Memorial is a hospital in upstate New York. Yolanda was a student at Ithaca College and studying to be a music conductor.
Yolanda was diagnosed with anal cancer and was to receive Mitomycin for her chemotherapy. Mary Jones, RN, inserted the IV on the day shift around 1300, and the patient, Yolanda, was to have Mitomycin administered through the IV. An infusion machine was used for the delivery. The Mitomycin was hung by Jeffery Chambers, RN, and he was assigned to Yolanda. The unit had several very sick patients and was short staffed. Jeffery had worked a double shift the day before and had to double back to cover the evening shift. He was able to go home between shifts and had about 6 hours of sleep before returning. The pharmacy was late in delivering the drug so it was not hung until the evening shift. Patricia Peters, PharmD, brought the chemotherapy to the unit.
On the evening shift, Carol Price, LPN, heard the infusion pump beep several times. She had ignored it as she thought someone else was caring for the patient. Diana Smith, RN, was also working the shift and had heard the pump beep several times. She mentioned it to Jeffery. She did not go into the room until about 45 minutes later. The patient testified that a nurse came in and pressed some buttons and the pump stopped beeping. She was groggy and not sure who the nurse was or what was done.
Diana Smith responded to the patient's call bell and found the IV had been dislodged from the patient's vein. There was no evidence that the Mitomycin had gone into the patient's tissue. Diana immediately stopped the IV, notified the physician, and provided care to the hand.
The documentation in the medical record indicates that there was an infiltration to the IV.
The hospital was testing a new IV infusion pump called SAFE-INFUSE. The supervisory nurse was Betty DePalma, RN. Betty took the pump off the unit. No one made note of the pump's serial number as there were six in the hospital being used. There was also another brand of pumps being used in the hospital. It was called Brand X infusion pump. Betty did not note the name of the pump or serial number. The pump was not isolated or sent to maintenance and eventually the hospital decided not to use SAFE-INFUSE so the loaners were sent back to the company.
Betty and Dr. William Brady are the only ones that carry malpractice insurance. The hospital also has malpractice insurance.
Two weeks after the event, the patient developed necrosis of the hand and required multiple surgical procedures, skin grafting, and reconstruction. She had permanent loss of function and deformity in her third, fourth, and fifth fingers. The claimant is alleging that, because of this, she is no longer able to perform as a conductor, for which she was studying.
During the procedure for the skin grafting, the plastic surgeon, Dr. William Brady, used a dermatome that resulted in uneven harvesting of tissue and further scarring in the patient's thigh area where the skin was harvested.
The risk manager is Susan Post, JD, who works in collaboration with the quality assurance director Amy Green. Amy had noted when doing chart reviews over the last 3 months prior to this incident that there were issues of short staffing and that many nurses were working double shifts, evenings, and nights then coming back and working the evening shift. She was in the process of collecting data from the different units on this observation. She also noted a pattern of using float nurses to several units. Prior to this incident, the clinical nurse specialist, Michael Parks, RN, MS, CNS, was consulting with Susan Post and Amy Green about the status of staff education on this unit and what types of resources and training was needed.