Restocking the Code Cart Case Overview This case involves a patient, Dixon, who suffered irreversible brain damage because a code cart was not properly stocked. The medical team had to intubate her in order for her to be placed on a ventilator. Once she was stabilized, it was determined by her physician to begin the weaning process and have the patient extubated. Following the extubation, the respiratory therapist felt that it was in the best interest for Dixon to continue to receive oxygen support through a mask; however, there was not one available in ICU so he went to another unit to obtain one. Upon returning, the patient was not breathing appropriately and another code was called which required her to be immediately reintubated. …show more content…
When a patient is declared brain dead because a code cart was not properly stocked, this is a serious issue and needs to be addressed. When a physician is done utilizing the code cart, there should be an individual appointed to ensure that it has been properly restocked for the next physician who needs it. Failure to confirm that all items that have been used are replaced again, does have an effect in the quality of treatment the patient receives. Whether the time it takes the individual to locate and replace that item during an emergency is seconds or minutes, time is a major factor in the patients’ health. As in our case, the patient’s care was prolonged by 3-minutes that indisputably resulted in her death (Pozgar, 2016, p. …show more content…
The employee that was responsible for checking the code cart and making sure that all items were there should be held somewhat accountable for the death of Dixon. Her death was not a result of a surgical error, incorrect diagnosis or a terminal diagnosis; it was due to a lack of oxygen. It is unfortunate that it had occurred however, I agree that Dr. Taylor was not negligent in this case. The hospital failed to train the employees properly on the importance of checking code carts after they have been used to make sure that whatever was used is
In July of 2010 in Miami, Florida, Richard Smith, a 79-year-old dialysis patient was admitted to the ICU after a dialysis appointment left him with severe shortness of breath. The following day after being admitted the patient complained of an upset and the doctor had prescribed him an antacid. Uvo Ologboride, the nurse taking care of Mr. Smith, gave him a deadly dose of a drug called pancuronium, which is a drug that induces paralysis, instead of the antacid. 30 minutes later the patient was found unresponsive, but they were able to revive him. Unfortunately when he was revived, he was left brain dead to which did not settle well with his family. When the patient son had came in he had found his father unconscious, unresponsive, and on a respirator. When looking over the chart to try and figure out what happened it had said his dad had just been resuscitated 10 minutes earlier and the nurse had pretty much told him to go and speak with the doctor. Upon speaking to the doctor he was told the nurse had given his dad the wrong medication which lead to his current state of his condition. The nurse was not able to be reached and spoken to about what happened on that fatal day but from what the doctor had explained was the nurse had grabbed a
While working at the OB-GYN department in the hospital, Dr. Vandall, as a Vice Chair of the Department of Obstetrics and Gynecology, learned that another employee of the hospital, Dr. Margaret Nordell was engaged in a level of treatment that was unethical and violated accepted standards of care. It was his duty to the hospital and to the patients, to monitor the competence of his staff members. Although he tried to take the proper steps to deal with it within the hospital, he ended up reporting this to the North Dakota Board of Medical Examiners. It was concluded by the Board that the treatment of Dr. Nordell was gross negligence and they suspended her license to practice medicine.
I agree with you that the nurses violated provision 9 of the nursing code of ethics. Nurses have an obligation to themselves, their whole team and to the patients to express their values. Communication is key in a hospital, so everyone knows what is correct and what isn’t within the workplace. In order to have a productive, ethical, positive environment. These values that should be promoted affect everyone in the hospital, especially the patients, and can have a negative outcome if those values are not lived out. Nurses have to frequently communicate and reaffirm the values they are supposed follow frequently so when a difficult situation comes along that may challenge their beliefs they will remain strong and their values will not falter.
Ohio Dep’t of Rehabilitation & Correction are the poor-quality patient care that Tomcik received and Tomcik’s health being at risk. Once engaged in a doctor-patient relationship, physicians are obligated to provide the best possible care for the patient by utilizing their skills and knowledge as expected from a competent physician under the same or similar conditions (“What Is a Doctor’s Duty of Care?” n.d.). However, in Tomcik’s situation, Dr. Evans did not deliver high-quality care, for he administered a perfunctory breast examination and thus did not follow standard protocols. There is evidence of indifference conveyed by Dr. Evans, and the lack of proper care towards Tomcik is an issue that can be scrutinized and judged appropriately. Additionally, Tomcik’s health was at risk due to the failure of a proper physical evaluation and the incredibly long delay in diagnosis and treatment. The negligence from Dr. Evans, along with the lack of medical attention sought out by Tomcik after she had first discovered the lump in her breast, may contribute to Tomcik’s life being in danger as well as the emotional anguish she may have felt during that time period. Overall, the incident of Tomcik’s expectations from the original physician and other employees at the institution not being met is an ethical issue that should be dealt with
They were part of the healthcare team and went along with the beliefs of their team. The team should have directly included the patient and parents. I cannot help but wonder if this legal battle would never have taken place had an ethics committee been assigned to this case. Ethics committees provide structure and guidelines for potential problems, serve as an open forum for discussion, and function as a true patient advocate by placing the patient at the core of the committee discussions (Guido,
I cared for a 76-year-old end-staged chronic obstructive pulmonary disorder patient who was admitted for respiratory distress. The doctor requested that my nurse and I get the family together for a family meeting. During the meeting, the doctor communicated to the patient and his family members that the patient will be palliative and no longer be in the ICU. The family members were concerned about the transfer of care to the medicine unit, what to expect from palliative care and other options for care. This scenario did not go well because the patient and family would have benefited from a palliative nurse with expertise, respiratory therapist to discuss other options, pharmacist about medication change if needed, social worker to help guide the family through end of life care for their father. In addition, there was no collaboration with interprofessionals prior to the family
In this paper, I will be arguing a that in the Please Let Me Die case, the patient did not give informed consent to rejecting treatment due to a variety of factors. In summary, the patient was a 25-year-old male named Dax Cowart who suffered severe burns over 65% of his body after a propane gas explosion. He had several fingers amputated and his right eye removed after he was stabilized. He was discharged with minimal use of his hands, totally blind, and needed assistance with daily activities. He asked that treatment be discontinued throughout his hospital stay and rehabilitation, but his request was denied because his physicians deemed him not competent. I believe he was not competent because of his injuries; as is said about many patients
Wickens, Lee, Liu and Gordon-Becker (2014) defined human error as the “inappropriate human behavior that lowers levels of system effectiveness or safety”. Human error consists of mistake, which is the intended action that turned out to be inappropriate; slip, which is the unintended incorrect act; and lapse, the omission of nonintentional errors (Wickens, Lee, Liu & Gordon-Becker, 2014). There are various instances of human error demonstrated in the case description including, the nurse entering the MRI room with the oxygen tank (mistake), failure to check the level of oxygen in the tank (lapse) and the oxygen tank accidentally flying over to Michael’s head
As the quantity of patients expanded, it ought to have been obvious that one registered Nurse and one Licensed Practical Nurse were insufficient to look after the patients. The emergency department ought to be viewed as a high priority location, and should have staffed with more Registered Nurses; Licensed Practical Nurse essentially do not have the training and abilities to assess patients or delegate the workload. Dangerous actions such as moderate sedation on a patient with no supplemental oxygen or EKG observing. The patient seems to have been overmedicated, with insufficient time between medications to decide his actual level of
The staff and myself got the patient on the CT table, on the monitor, and on oxygen. The physician came to CT for the procedure he ordered starting sedation doses of 2 mg versed and 100 mcg of fentanyl, I told this physician I felt the doses should start at 1 mg versed and 50 mcg of fentanyl, and then we can always give more. He insisted the doses he ordered be administered. I was not comfortable with the order, but I administered the medications as ordered. The patient quickly developed snoring respirations, he was maintaining a good oxygen saturation, but I know he was on the brink of decompensating. I was concerned he would not be able to maintain his own airway, he was over sedated. The physician and the CT staff were in the control room waiting for me to step out of the CT room so they could do the preliminary CT scan and start the biopsy. I refused to leave the CT room until I felt comfortable with the patient’s respiratory status. Once the biopsy was over I discussed with the physician that I would never administer a dose so high at one time for any
There was inappropriate staffing in the Emergency Room which was a factor in the event. There was one registered nurse (RN) and one licensed practical nurse (LPN) on duty at the time of the incident. Additional staff was available and not called in. The Emergency Nurses Association holds the position there should be two registered nurses whose responsibility is to prov...
The Lewis Blackman Case: Ethics, Law, and Implications for the Future Medical errors in decision making that result in harm or death are tragic and costly to the families affected. There are also negative impacts to the medical providers and the associated institutions (Wu, 2000). Patient safety is a cornerstone of higher-quality health care and nurses serve as a communication link in all settings which is critical in surveillance and coordination to reduce adverse outcomes (Mitchell, 2008). The Lewis Blackman Case 1 of 1 point accrued
The hospital under vicarious liability is based on Respondeat Superior (let the master answer) for the negligence actions of its contractors/employees. This is the responsibility of physicians for negligent actions of hospital employees ranging from nurses to x-ray techs. Through Corporate Liability the hospital itself is liable for the negligent actions of its workers.
My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to protect her safety and dignity, whilst also trying to ascertain what was going on. During the unresponsive episodes we returned the patient to the stretcher where she spontaneously recovered and refused hospital treatment. I completed my patient report form to reflect the patient's decision and highlighted my concerns. The patient’s intoxicated husband then carried his wife back into the house.
patient by a few more weeks or months, they do nothing to return a patient to a