Details:
One paper, between six (minimum) and eight (maximum) pages in length (excluding title and reference pages), on a topic of interest that has resulted in a malpractice claim involving the violation of a professional standard of nursing practice or law with respect to the ethical and or political ramifications.
An article informing the reader of the types of paid claims (in accordance with the National Practitioner Data Bank 1990-2014)) and related patient outcomes is attached below for reference.
***The scholarly paper must have the following guidelines:
1. Statement of the violation; description of the act of omission/commission and a detailed description of the related patient outcome.
2. In depth description of the Standard of Practice or Law involved.
3. Analysis of the legal considerations of the case.
4. Analysis of the ethical and/or political considerations of the case.
5. Summary of the facts involved.
6. Statement of personal opinion & justification for your judgment of the case.
7. Use of APA guidelines and appropriate references. (at least 3 references)
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Nursing Malpractice Claim
Nursing is among the largest regulated health professions in the world, considering the vitality of their job. Any wrong move by a nurse could lead to injury or death of the patient. However, most nurses are now finding themselves becoming defenders in malpractice claims. The nurse is claimed to have engaged in malpractice/ professional negligence, which is not performing their professional duty as a licensed professional (Lippincott Nursing Education, 2018). Nurse malpractice is governed under Medical malpractice law, which is a specialized area of law dealing with negligence claims.
This paper will look into one nurse malpractice claim involving the failure to record an inaccurate record keeping of a patient’s condition, specifically the changes that happened. The standards of practice or law involved, legal, and ethical considerations will be addressed. Finally, a personal opinion towards the case is to be provided together with the respective justification.
Statement of Violation
A patient’s medical records are an intrinsic and fundamental element in a patient’s healthcare. The purpose of these records is documentation of care given to the patient, communicating, and guiding all the care providers on the treatment and care (Di Leonardi, 2012). One of the nurse’s fundamental responsibilities is to maintain comprehensive and correct records that are a description of the patient’s condition, treatment, and care.
From a legal standpoint, the significance of documentation is equivalent to the total care given. If a particular action has not been documented, the law presumes or infers the operation is not performed, which results in legal liability. The documentation errors that generally end up in court include the failure to indicate the date and time of a medical entry, failure to document the pertinent health and drug records in enough detail, failure to document the previous treatment events, failure to record the medications administered, making records on the wrong patient’s charts, failure to file the discontinuation of the administration of a particular medicine, failure to register drug reactions os a patient to a specific medication, sloppy illegible handwriting, documentation of subjective data improper transcribing of orders, and transcribing orders improperly (Lippincott Nursing Education, 2018).
Wrongful documentation or failure to document could lead to injury or death of a patient since their lives depend on the accuracy and availability of the treatment information.
Law/ Standards of Practice Guiding Documentation of Patient Records by Nurses
The federal regulation, 42 C.F.R. §483.75(l)m focuses on clinical records giving particular directions on their handling. This regulation requires facilities to maintain clinical records of clinical records for each patient according to the accepted professional standards and practices. This entails the documents being complete, accurate, readily accessible and systematically organized. Additionally, the clinical records should have adequate information to illustrate the entity knows the precise status of the individual, has enough plans of care with evidence to prove the effects of care already provided. It is through documentation that a clear image of the patient’s progress, treatment responses, condition changes, and treatment changes.
HIPAA (Health Insurance Portability and Accountability Act of 1996 sets the standards of use by healthcare organizations of the protected health information (PHI) (Di Leonardi, 2012). The Act’s main objective is upholding the privacy and security of patient information while guaranteeing the patient’s access to their health information and control of the disclosure procedures. In regards to documentation, HIPAA outlines the responsibilities of nurses in protecting the report, which includes protecting passwords, logging off computers promptly, closing medical records when not in use, allowing patients to view particular sections of the files, among others (Di Leonardi, 2012).
The American Nurses Association (ANA) has the role of development and maintenance of the scope of nursing practice statement and the standards of practice applicable. The ANA’s Standards of Professional Nursing Practice address the competent levels of the nursing case, as illustrated by the critical thinking model, the Nursing process. The Nursing process encompasses the assessment, diagnosis, identification of outcomes, planning, and implementation (American Nurses Association, 2010). Significant actions have been listed which registered nurses are to follow as they form the basis of their decision-making. In regards to nursing documentation, ANA has made several publications that document the standards of practice to be followed.
● Nursing: Scope and Standards of Practice (2010) that constructs the code of ethics and social policy statements that lay out the expectations of the professional nurse and their accountability to patients, clients, and society (American Nurses Association, 2010). Documentation is an essential element in the respective standards outlined together with their competencies.
● The Nursing Social Policy Statement: The Essence of the Profession (2010) is ANA’s description of the pivotal nature and functions of professional nursing. It considers the social dimension of nursing, which informs the whole person epicenter of nursing that is reflected in nursing documentation (American Nurses Association, 2010).
● Code of Ethics for Nurses with Interpretive Statements (2001) outlines the moral and ethical foundations that guide nurses in their professional settings. The nurse is responsible for promoting, advocating, and striving to protect the health, safety, and rights of their patients (American Nurses Association, 2010).
Case Facts Summary
Mrs.H was a 71-year-old resident of a skilled nursing facility for six years. Her medical history was significant in terms of the ailments she suffered, including severe malnutrition, pneumonia, U.T.I. and brittle diabetes mellitus (Wilson, 2018). Her physical abilities had been negatively affected that she needed Helpance in most activities of her daily living. She also had a history of cognitive deficits and refusal to take treatments and medicine. Most of the period she was in the residency, she had several hospitalizations for shortness of breath and diabetes ketoacidosis (Wilson, 2018).
One evening at around 1.00 AM, the patient Mrs.H noted that she was finding it hard to breathe. The nurse would note down the room’s oxygen saturation was at 80% of room air, and the patient was put on oxygen at 2litres each minute. No further documentation was made. At 2.00 AM the same night, the patient was documented as being coherent and had no indications of oxygen saturation (Wilson, 2018). She declined being hospitalized after being asked to do so. The nurses would take no further actions, including not calling the physicians or family to communicate about the changes in condition. The same response by the nurses would follow at 3.00 AM when the saturation of oxygen dropped to 70% and later increased to 72%. As at 4 in the morning, the levels were now ranging between 61 and 62%. When the patient was asked whether she is to be hospitalized, the nurse recorded that she shook her head to indicate “no” (Wilson, 2018). While the patient was not responding verbally, the nurse believed that the patient was still coherent and capable enough to make her own decisions regardless of the low oxygen levels.
More than two hours later, at 6.30 AM, the patient was scheduled for a check on her blood sugars, but her records were not shown whether the test took place, nor were there reasons for its failure. An hour later, the patient’s daughter was notified of the change in condition. The same hour, her records indicated that the patient was not responding to verbal stimuli, had lower blood pressure, and increased heart rate (Wilson, 2018). The nurse tried to reach the on-call physician who was not reachable until an hour later, after being called from the physician’s office. The nursing home chart had no records of any information exchange during the call, nor the immediate orders received, at 9.15 AM, Dr, M who was doing rounds gave a verbal order to have the patient taken to the emergency department which would occur an hour later (Wilson, 2018). The patient passed on after seven days in hospice care. The cause of death being diabetic ketoacidosis, protein and calorie malnutrition, and diabetes mellitus for days, months, and years respectively.
The three daughters to the patient would sue the Nursing Home facility for medical malpractice, elder abuse, and wrongful death. The claim indicated inaccurate record keeping, failure to document and the failure to report the changes in condition while receiving reimbursement for Medicare, yet they did not offer the required resources.
Legal Considerations of the Case
Nursing Standard of Care, which is the level of care that an average reasonable nurse should provide to their patients using general nursing knowledge and not the thoughts of specialists (Dimond, 2008). The standard of care that a nurse offers will depend on the time of the incident in which it is applicable. In this case, the first basis of litigation would be failing to exercise a level of care that a prudent, reasonable nurse should have offered in the same circumstances. She was not a new patient, and hence the nurses were aware of her medical condition. This would have been the basis for reasonable care to the patient.
Nursing Malpractice is nurses being negligent or breaching their duties as professionals (Dimond, 2008). In proving malpractice, there are four elements that the plaintiff should prove. The four items are the nurse having a duty of care to the patient, the nurse breached that duty, a patient injury occurred, and there existed a causal relationship between the breach of duty and the patient’s injury (Dimond, 2008). The nurse who was taking care of Mrs.H was an active care provider to the patient as the latter had been in the nursing facility for a long time. This means that the nurse did have a duty of care to the patient. The second element is the breach of duty of care by the patient. This entails committing an act of committing a process of attention to the patient and whether it resulted in the patient getting injured. The nurse taking care of Mrs.H did not make any documentation for every check she did on that night. This is primarily on the oxygen saturation levels. Additionally, even when the levels consistently dropped, and there was an unusual change in the patient’s condition, the nurse did not take prompt action to call the on-call physicians. In the morning, the physician who came would have the patient be rushed to the emergency room due to challenges in vital body functions, which later she would die from the related disease.
The third element is the proximate cause, which the nurse’s actions did cause harm to the patient. The failure of the nurse to call the physician of changing conditions who would have responded to the emergency immediately-led to the patient’s vital body organs deteriorating, and she died later. The fourth element is the damage to whether the harm was a result of the nurse not offering standard nursing care, which is true. The nurse failed to adequately protect the patient and implement the complete nursing process, including proper documentation.
Ethical Considerations of the Case
Nurses need to make moral decisions on care delivery, patient advocacy to plan and provide safe patient care. The ethical decisions are to be guided on the six principles of respect, beneficence, nonmaleficence, justice, veracity, and fidelity. The nurse, in this case, failed to uphold the beneficence, nonmaleficence, and fidelity principles in the decisions she made. Beneficence entails doing good, and this was not seen when the nurse was unable to inform the right authorities of the deteriorating condition of the patient. Nonmaleficence involves avoiding harm, yet the nurse watched the patient suffer for all that time since the status did change. Fidelity means being true to one’s commitment, which for the nurse is the utmost patient care that a reasonably prudent nurse should have.
Personal Opinion & Justification of Personal Judgment
The patient’s conditions were changing from oxygen saturation. According to 42 C.F.R., a facility is expected to immediately consult with the resident’s physician and notify the authority of the change of condition. This is a practice that a nurse should be aware of and act on it promptly. However, the nurse failed to do so, putting the patient’s life at risk. The patient was ill and unresponsive hence becoming inappropriate to wait over an hour for a response. The nurse could also use her judgment to call for emergency transport, but it is not acceptable to watch a patient’s condition deteriorate and do nothing.
The multiple instances of the nurse not keeping records also raise concern. The notes available were not legible; the narration of the occurrences did not align with the times listed on the margins showing that they could have appropriately been done way after the event. The nurse did fail in heeding to the documentation practices of being clear and accurate in terms of how the conditions were changing. There was no explanation for why the breakfast blood sugar check was not done. Considering the many wrong actions done by the nurse, it shows that the nurse did breach her duty of care that led to the patient’s death. This makes the nurse legally liable for the damages.
References
American Nurses Association. (2010). ANA’s principles for nursing documentation: guidance for registered nurses. Silver Spring, MD: ANA, Nursebooks.
Di Leonardi, C. B. (2012). Professional Documentation: Safe, Effective, and Legal. AMN Healthcare Education Services. Retrieved from https://lms.rn.com/getpdf.php/1939.pdf
Dimond, B. (2008). Legal aspects of nursing. Pearson Education. Retrieved from https://www.nursingcenter.com/upload/static/403753/ch03.html
Lippincott Nursing Education. (2018, February 22). Nursing documentation: How to avoid the most common medical documentation errors. Retrieved from https://nursingeducation.lww.com/blog.entry.html/2018/02/22/nursing_documentatio-S5hF.html
Wilson, W. C. (2018). Inadequate Nurse’s Notes Lead to Lawsuit. Caring for the Ages, 19(3), 14-15.
