Standards of care
Standards of care – which standards of care were violated
and who was responsible?
In your role as a nurse practitione/r, what risk management
steps should be taken before or after the incident to alleviate the issue?
Case Study: Malpractice Action Brought by Yolanda
Yolanda Pinellas is a 21-year-old female studying to be a
music conductor. She was admitted for chemotherapy. The medication mitomycin
was administered by intravenous infusion through an infusion pump.
During the evening shift, the infusion pump began to beep.
The RN found that the IV was dislodged, discontinued the infusion, notified the
physician, and provided care to the infusion site. The patient testified that a
nurse came in, pressed some buttons, and the pump stopped beeping. She was
groggy and not sure who the nurse was or what was done. The documentation in
the medical record indicates that there was an IV infiltration.
Two weeks after the event, the patient developed necrosis of
the hand, required multiple surgical procedures, skin grafting, and
reconstruction. She had permanent loss of function and deformity in her third,
fourth, and fifth fingers. The patient alleges that, because of this, she is no
longer able to perform as a musical conductor.
While reviewing charts, the risk manager had noted that
during the 3 months prior to this incident, there were short-staffing issues
with many nurses working double shifts (evenings plus nights) then coming back
to work the evening shift again. The risk manager also noted a pattern of using
float nurses among several units.
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