In: Nursing
Read the narrative below describing a scenario that occurred in a hospital Emergency Room. Identify at least 4 incidents/problems that occurred in the narrative. Explain why and how you think they are incidents/problems. Then, offer suggestions on how to solve each incident/problem.
James is an ER triage nurse at Trillium Health Partners in Mississauga, Ontario. On Monday, April 24th, 2020, James reported working as usual at 7:00am. On this particular, he was working with his RN colleague Melissa, who had to take a double shift because Richard (the RN who typically works Mondays) was ill. At roughly 8:30am, a patient by the name of Charles Becker entered the ER, grasping his right shoulder. He approached James’ desk.
“Hi there,” remarked Charles, who was seemingly in pain.
“Hi. What brings you to the ER?” asked James.
Charles explained that he was involved in an accident at home whereby he fell from his porch and landed on his shoulder, which he thinks is now dislocated or broken.
“Ok, let me take your temperature and blood pressure,” said James, preparing the instruments.
“Nurse, can I please have some Tylenol or something. It really hurts,” inquired Charles.
“I will go double-check with the doctor,” assured James. “No fever, so that’s good. Your blood pressure will show in a second”
Just then, Melissa joins them in the room, hunting intently for her eyeglasses that she left there earlier.
“Hey Melissa,” says James, “do me a favour and record Charles’ blood pressure. I have to quickly ask the doctor something.”
Rushed, Melissa notes 133/88. It actually read, 188/98. Normal blood pressure is roughly 120/80. She then remembers leaving her glasses in the bathroom when she washed her face.
“Hey Doctor Fleming,” says James. “Quick question for you. There’s a-“
“Mr. James,” Doctor Fleming interrupts, “do you not see that I am reading an MRI report? As a nurse, you should recognize the importance of not distracting us physicians when doing important duties such as these.”
James is furious and embarrassed at the same time. He remains silent and begins to walk away.
“Wait,” Doctor Fleming remarks. “What is it now that you are here?”
“An ER patient is requesting medication for pain. Looks like he dislocated his shoulder. Can I give him anything in the meantime?”
“Acetaminophen is fine James,” responded the doctor. “I am going to go speak with the radiologist upstairs for a minute. I’ll be back in a few.”
James returned to the triage area. He gave Charles two extra-strength Tylenol caplets and a bottle of water. Charles returned to the waiting room.
After 15 minutes, Melissa calls out, “Charles, you are next.” Charles rises from his chair and quickly collapses to the ground. He begins to violently seizure.
Melissa runs towards Charles, calling out “James, get over here please.” James joins Melissa with some medical instruments to attempt to settle Charles.
“What the hell happened?” James claims, as he straps the blood pressure machine cuff on Charles. “195/125! He is in hypertensive crisis! How can this be? Melissa, what was his bp earlier?”
Melissa responds, “I don’t remember exactly, but something stable like 130/85. Wait, let me just check the machine’s memory data.” 188/98.
“If it was that high to begin with, then… oh no… the Tylenol! Acetaminophen will increase blood pressure,” James stated with fear in his voice. James and Melissa knew that Charles needed medication to quickly lower his blood pressure before any organ damage began.
“Okay, I’ll get Doctor Fleming in the back,” Melissa remarked.
“He’s not there. He went upstairs to radiology. We don’t have time Melissa. Just get the clonidine and captopril now!” yelled James.
Melissa stuttered, “B-b-b-but James… we can’t. You know that… I mean, look what just happened because we didn’t double-check.”
Just then, Doctor Fleming turned the corner from the elevator exit. He ordered the administration of clonidine and captopril. Charles came out of the seizure and was immediately admitted for continued care.
the problems or incidents happened are listed below:
1. problem: james transferred his duty of checking blood pressure to melissa who was busy checking her eye glasses. since she was not oriented, she read out the blood pressure reading wrong. actually the reading was extremely high.
solution: james could have spent time to check the blood pressure by himself as melissa is busy.
2. problem: the blood pressure reading was not double checked before administration of medication.
solution: james had to double check the blood pressure reading before administration of medication.
3. problem: even the doctor didnot enquired about the vital parameters before prescribing the medication
solution: the doctor could have met the patient and confirmed the readings of vital parameters before prescribing dmedicaton.
4. problem: james did not check the strength of the medication before administering to the patient
solution: he should have checked the strength, dose before administering the medication.