Question

Please read the Case Study below which is titled "Nurse Injects Patients With Lidocaine"

After you review the case, please discuss the processes hospitals should implement to prevent such occurrences in the future. Your initial post of at least 150-200 words is due Thursday by 11:59pm. Your post must include at least one scholarly source, cited in APA format. Two peer replies are due Sunday by 11:59pm. People v. Diaz (1992) 3 Cal.4th 495 , 11 Cal.Rptr.2d 353; 834 P.2d 1171 I.

Facts On March 29, 1981, defendant, a registered nurse, began work on the night shift in the cardiac care/intensive care unit (ICU) at Community Hospital of the Valleys (CHOV) in Perris, California. In the next three and one-half weeks, at least thirteen patients on the night shift suffered violent seizures, which were generally followed by cardiac and respiratory arrest. Nine of these patients died. The nurses who had observed the seizures described them as being similar to grand mal seizures suffered by epileptics; none of the nurses had ever seen such symptoms in cardiac patients. Following the closure of the ICU at CHOV, defendant accepted employment at San Gorgonio Pass Hospital. Within three days, while defendant was on duty, a patient died at that hospital after displaying the same symptoms as those observed in the patients who had died at CHOV. Within a day or so, defendant was arrested and charged with murdering a total of 12 patients (including 2 in whom seizures were not observed). At trial, the prosecution contended that defendant had killed the 12 patients by injecting them with massive overdoses of lidocaine, a drug commonly used in hospitals to control rhythm disturbances in the heart. All but one of the deceased patients had been given therapeutic doses of lidocaine while in the hospital's ICU. The prosecution's evidence showed that defendant assisted in the care of the patients before their seizures, and thus was in a position to administer fatal doses of lidocaine; that on several occasions defendant exhibited unusual behavior on nights when patients died; that the patients' symptoms were consistent with having been given large overdoses of lidocaine; that the patients' tissues or blood had unusually [3 Cal.4th 518] high concentrations of lidocaine; that syringes containing high concentrations of lidocaine were found in the hospital; and that lidocaine was found in defendant's home. The defense theorized that some of the deaths resulted from natural causes, while others were caused by adverse reactions to medications administered for therapeutic purposes. Although the deceased patients had suffered from serious medical problems, many of them were not regarded as terminally ill. The evidence presented at trial does not suggest that the deaths were "mercy killings"; the prosecution did not argue such a theory at trial, nor did it suggest any other motive for the slayings.

Answer 1

It requires detective work for hospitalists and toxicologist to find out what is the reason of a life-threatening overdose in an unresponsive patient.Drug overdoses are a very serious and rapidly growing public health problem.There is a incrase in intentional poisonings from these drugs.Identifying drug overdose mortaity has important implications for surveillance and policy.

Drug overdoses can be accidental or intentional.if a patient has been given more than the recommended amount he is definitely overdosed.The health care delivery system is vulnerable to medical errors.Unsatisfactory patient outcomes and malpractices are dealth with grave consequences.Disclosureof medical errors to patients and family members serve as a catalyst for litigation and thusthe establishment of appropriate moral and ethical standards which cannot be ignored when implementing solutions to remedy the situation.Proactive management of organizationl ethics in health care is imperative

Although ultimately the board of trustees is responsible for the assurance of the qualiity of care in the hospital as a whole ,the actual measurement and tracking of performance improvement is delegated to the staff of the unit .The unit director in collaboration with the nurse manager and other members of the health care team should attempt to identify areas for improvements in care delivery.A formal plan should be developed and implemented using the process of identifying an issue ,implementing change and remeasuring.PDSA process ie plan,do,study act or PDCA ie plan,do,check ,act.Results should be communicated both up and down the hierarchy.

Brill RJ,Spevetz A,Branson RD ,et al :Critical care delivery in the Intensive care unit:Defining clinical roles and the best practice model.Criti Care Med 25:1007-2019,2001.