Finding a defense to case-level of fatigue


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• Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

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To Comment:

Finding a defense to this case is challenging. There is definitely some negligence regarding the care Ms. Pinnelas received. I really want to take the time to focus on the nursing standards of care for the patient. Mary Jones started the IV. It was never mentioned in the facts if the IV site was used for fluids or administration of medication prior to Jeffrey Chambers hanging the Mitomycin. We have no idea if the IV was patent prior to this. None the less, knowing that Mitomycin is a vesicant, proper IV placement should have been checked prior to administration of this medication in a peripheral line. This is not stated in facts and could be found as negligent if not completed prior to starting the infusion. Westrick (2014) reinforces that "administrating medications incorrectly is one of the most common areas of nursing negligence" (p. 33).

It is a fact that Jeffrey Chambers was fatigued. Brown (2016) states RNs' have a responsibility to evaluate their level of fatigue when deciding to accept or reject any assignment extending beyond their regularly scheduled workday or week. Ultimately, when a nurse accepts the assignment they are agreeing that they can fully care for the patients under their care. It is the individual nurse's decision to accept the care of this patient but that also does not excuse the facility. The facility risk management team should have a clear policy regarding work, sleep/rest periods and promote healthy nurse work hours in all roles and setting (Brown, 2016).

Risk management could take a more aggressive approach to the staffing situation on the floor. In the facts of the case, it was known to the risk management department for 3 months about the staffing situation and the floating of the staff. This should raise alerts about the potential of an adverse event such as this occurring. An effective risk management program can help to promote patient safety and improve the quality of care provided in the office-practice setting and reduce professional liability exposure (Miller, Miginsky, & Connelly, 2012). In this instance, the risk manager could approach administration, discuss the potential for adverse events, and formulate a staffing plan to include proper education of floating staff and overall manning of the unit. This could prove to be beneficial for the facility and help protect the patient from the adverse event that occurred to her.

Reference:

Brown, G. (2016). Averting malpractice issues in today's nursing practice. The ABNF Journal, 25-27.

Miller, V. B., Miginsky, C. S., & Connelly, N. C. (2012). The risk manager's contribution to patient safety and risk management in the ambulatory or physician practice setting. Journal of Healthcare Risk Management, 31(4), 31-39.

Westrick, S. J. (2014). Essentials of nursing law and ethics (2nd ed.). Burlington, MA: Jones & Bartlett Learning.

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