Question

Ms. Gadner was driving her car on the highway when another car driven by Mr. Sneed passed her, sideswiped her, ran her off the road, and drove off. She caught up with Mr. Sneed and forced him to stop. She got out of the car and started to walk to his car when he drove away. When she was walking back to her car, Mr. Otis struck her with his vehicle. Gadner was transported to Bay Hospital, a small rural hospital, where Dr. D, a second year pediatric resident, was the attending emergency room physician.

Upon arriving at Bay, Gadner's skin was cool and clammy and her blood pressure was 95/55, indicative of shock. Gadner received 200 cc's per hour of fluid and was x-rayed. She actively requested a transfer because of vaginal bleeding. Nurse Gilbert voiced her own concerns about the need for a transfer to the other nurses in the emergency room, but not to Dr. D. Dr. D did not order a transfer.

Bay is a rural hospital and is not equipped to handle trauma patients with multiple injuries like Gadner. Bay had no protocol or procedure for making transfers to larger hospitals. Bay breached its own credentialing procedures in hiring a physician who lacked the necessary training, expertise, or demonstrated competence to work the emergency room. Dr. Moon, the hospital's chief of staff, had screened Dr. D, but a proper evaluation was not performed before he was hired. A second year pediatric resident is not normally assigned to an emergency room setting, because they lack enough experience to handle true emergency cases.

The nurses failed to notice that Gadner was in shock and this failure was substandard. After they initially noted that she arrived with cool and clammy skin and a blood pressure of 95/55, they did not advise Dr. D that the patient was likely in shock; they failed to place her on IV fluids, elevate her feet above her head and give oxygen as needed. Dr. D ordered the administration of 500 cc's of fluid per hour, but Gadner received only about 200 cc's per hour because the IV infiltrated, delivering the fluid to the surrounding tissue instead of the vein. The nursing staff normally would discover infiltration and correct it. Scanty nurse's notes reveal that vital signs were not taken regularly, depriving Dr. D of critical and ongoing information about Gadner's condition.

Nurse Gilbert administered Valium and morphine to Gadner, following Dr. D's orders, a mixture of drugs counter-indicated for a patient with symptoms of shock. Nurse Gilbert did not notice or protest.

Three hours after arriving at Bay, Gadner "coded" and Dr. Dick tried unsuccessfully to revive her. After she "coded," Dr. D attempted to use the laryngoscope, following standard practice, but the one provided was broken. He then ordered epinephrine, but there was none available in the emergency room. A coroner performed an autopsy and it was determined that Gadner died of treatable shock.

It is not required, but the use of a table is helpful in developing your responses and ensuring you cover everything.

1. develop a second VERY SPECIFIC list of long term (6 - 12 months) corrective actions the hospital must take to ensure this situation does not happen again. Be sure to have a long term corrective action for EACH of the legal issues you identified. (This list should NOT be same as the short term actions, but should instead build upon EACH of them.)

Answer 1

The very specific long term correction that the hospital can do in 6 to 12 months is to hire a good quality trained and experienced doctors and nurses to the emergency department.Also they can focus on continuous training to identify the emergency situation.

The long term corrective action to avoid the issues are

1.Equip the hospital with proper equipments which is necessary for managing critically ill patients.This should include the trained and experienced nursing staff and doctors also the machineries.

2.Make a proper protocol for the hospital in terms of patient transfer to higher centers and try to make MOU(memorandum of understanding) with anyone of the nearby higher center.

3.Make a policy to protect the patient right.

4.Make the list of emergency medicines that should be available in the emergency department and maintain the inventory properly.

5.Improve the communication skill of the staff.

6.Keep training the staff regarding the emergency management and the nursing care,also to identify critical situations.

7.Never let the patient yo die with any treatable conditions.It is possible only with the help of hiring good quality nurses and doctors.