Good Case Study On Following The American Psychological Association’s Guidelines

Summary

A 72-year-old woman, the plaintiff, had received care for acute back pain as a result from a fall. Medical history included pain management and therapy. She had end-stage renal disease and was receiving hemodialysis. She was to be transferred to a separate, co-defending facility, to finish her therapy before returning home. Prior to this, the facility noticed the defendant was prescribed to different doses of morphine to be administered twice a day, equaling for separate doses of morphine. They contacted the on-call nurse practitioner (defendant). The defendant instructed the facility to label the correct prescription and dosage, and not to move the patient until after the transferring hospital’s pharmacist had cleared the prescription. This was the last communication the defendant had concerning the morphine. The transferring facility’s pharmacist approved both morphine prescriptions; the patient was transferred.
The first evening and day, the patient was fully responsive. She was found without vitals the second day. Despite attempts to resuscitate, the plaintiff was pronounced dead. The autopsy stated morphine intoxication as cause of death. The plaintiff also had an elevated blood alcohol level. The source of alcohol was unidentifiable, thus the examiner was unable to rule out foul play. Cause of death was left undetermined. Despite this, the nurse’s actions were found to be within the standard of care. The defense stated final morphine levels were lethal, but were more than the amount prescribed. They questioned if the patient had received morphine and alcohol from somewhere other than the health facility. The case was settling prior to trial with no liability on behalf of the nurse Practitioner.

Discussion

Based on my review, I do agree with the court’s decision. According to Judith A. Berg and associates’, “Where We Are Today: Prioritizing Women’s Health Services and Health Policy,” the typical standard for women’s health care has fallen dangerously below the national average . This statistic is truer for elderly women, who are often prioritized behind female children, female teens, and younger women . Therefore, it is a testament that either defendant glanced at the plaintiff’s chart long enough to notice there was an issue with her medication or her dosages.
While the dosages were checked, and an attempt was made to save her, it still resulted in an elderly woman’s death. Many believe somebody should be held responsible, but I agree with the court’s decision. Janie B. Butts and Karen L. Rich state in, “Nursing Ethics: Across the Curriculum and Into Practice,” that it is beneficial to provide emotional support to patients, but not to be too attached because they will eventually leave your care. Once they leave your care and go home or are transferred, you are no longer allowed to make medical decisions for them . Therefore, ethically the nurse practitioner, and defendant, acted responsibly in this situation and cannot be held accountable for the plaintiff’s death. The facility contacted the defendant and the defendant stated the transferring hospital’s pharmacist should be contacted in order to verify which prescription should be used in order to avoid putting the patient at risk. Once the defendant advised the transferring hospital staff of these instructions, and the transfer was made, the defendant was legally safe to assume the instructions had been followed .
If I were to disagree, I would say charges should have been filed against staff at the facility. They failed the plaintiff. It appeared charges were only filed against the defending nurse practitioner at the original facility the plaintiff was treated at, but this was an incorrect action. The defendant gave orders to help ensure the plaintiff remained healthy upon her transfer. The orders were not followed, nor were she given proper care at the new facility. Any chargers files should have been against those were charged with her care at the new facility.

Practice-Related Standard of Care/Breach?

A standard of care, as stated in Pamela J. Grace in, “Nursing Ethics and Professional Responsibility in Advanced Practice,” refers to a manageable and reasonable watchfulness professionals maintain over patients . Standard of care also refers to the attention paid to a patient, as well as the caution that professionals exercise in their care toward a patient . Failure to meet a proper standard of care counts as negligence. In these situations, there was a breach in the practice-related standard of care on two separate occasions. The first occasion consisted of one individual at the transferring facility failing to follow the defendant’s orders by allowing the pharmacist to clear both of the plaintiff’s morphine prescriptions. This effectively allowed the plaintiff to receive double, if not more of the recommended dose of morphine, per day.
The second breach in the standard of care concerns her death itself. Any time a patient passes away unexpectedly, it can be cause for a breach in standard of care. In this situation, the autopsy revealed the plaintiff died of morphine intoxication, but also had enough alcohol in her system to signify three to four alcohol drinks having been consumed. Later it was revealed the amount of morphine in her system exceeded the amount of even the unnecessary prescription. Consequently, we know the plaintiff must have received morphine and alcohol from somebody in the facility, had it brought to her, snuck it in, or had enough time to leave in order to consume it. Standard of care assumes those charged with the care of patients will watch over them, care for them, and ensure their safety. The plaintiff’s excessive morphine levels, as well as her alcohol levels suggest that she was not being cared for at all, signifying a severe breach in practice related standard of care.

Risk Management Action Plan

Because the death of the patient was ruled undetermined, it is difficult to know what happened. All we have to make a plan is speculation. She had more morphine than her prescriptions would have allotted in her system, which is thought to be the cause of death. However, she also had enough alcohol in her system to equal three to four alcoholic beverages. She was not a very healthy women, but the only options are she was able to sneak out of her room in order to get to these commodities, or there were snuck in to her. This, fortunately, leaves few options when creating a risk management plan.
Other techniques can be used to ensure safety when it comes to patients. Behaviors as simple as double checking charts and prescriptions, or following the orders of nurse practitioners can help ensure that nobody’s integrity is called into question when a patient in transferred and questions arise. Double-checking prescriptions and enforcing proper dosages with pharmacists also ensures patient safety. Proper standard of care, including, but not limited to, not sneaking patients extra medication or alcohol is also a good step in an action plan. Furthermore, patients should be checked on regularly. It is possible the patient had enough time to sneak out of her room and gain access to medications, depending on her health. Risk Management Plans that include regular rounds checks would not allow patients to do this. Visitors should also be checked, and should not be allowed to enter patient’s rooms with bags or anything bulky, in case they are sneaking in anything that might harm the patient.

References

Berg, J. A., Taylor, D., & Fugate Woods, N. (2013). Where we are today: Prioritizing women’s health services and health policy. A report by the Women's Health Expert Panel of the American Academy of Nursing . Nursing Outlook, 5-15.
Butts, J. B., & Rich, K. L. (2013). Nursing Ethics: Across the Curriculum and Into Practice. Burlington: Jones & Bartlett Publishers.
Grace, P. J. (2013). Nursing Ethics and Professional Responsibility in Advanced Practice. Burlington: Jones and Bartlett Publishers.
Nortvedt, P., Hem, M. H., & Skirbekk, H. (2011). The ethics of care: Role obligations and moderate partiality in health care. Nursing Ethics, 192-200.