Showing posts with label Shift Work And Patient Safety. Show all posts
Showing posts with label Shift Work And Patient Safety. Show all posts

Monday, November 21, 2011

Patient Left Unrestrained, #Patient Injured. #Nurses Judgement Call, #nursing #malpractice #nursefriendly #epatient #negligence

See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety:

Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Attorneys, Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material.

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Summary: The decision to use or not use restraints must be made with caution and good judgement. Their intended purpose must be to protect either the patient or others who may be injured by the patient including the staff caring for the client. The ultimate determination of necessity is left with the physician. Often, the moment to moment necessity is determined by the nurse. In this case a nurse did not feel restraining the patient was necessary. When an injury occurred, the patient sued.

The patient was involved in a motor vehicle accident. A head injury was suffered leaving him in a state of confusion and prone to agitation.

"Each year, an estimated 2 million people sustain a head injury. About 500,000 to 750,000 head injuries each year are severe enough to require hospitalization. Head injury is most common among males between the ages of 15-24, but can strike, unexpectedly, at any age. Many head injuries are mild, and symptoms usually disappear over time with proper attention. Others are more severe and may result in permanent disability." 2

Following the head injury, the patient was visibly confused and frequently became agitated. During the course of his admission, an order for "soft" wrist restraints was obtained and implemented to protect the patient from injury related to mental status (personality) changes.

"Personality Changes-Apathy and decreased motivation. Emotional lability, irritability, depression. Disinhibition which may result in temper flare-ups, aggression, cursing, lowered frustration tolerance, and inappropriate sexual behavior."2

On the day of the incident, the nurse on duty had assessed the patient. In her professional opinion restraints were not needed.

"What Is Restraint?

"Restraint" is physical force, mechanical devices, chemicals, seclusion, or any other means which unreasonably limit freedom of movement. hospital staff may use four types of restraint to restrict patients who are acting, or threatening to act, in a violent way towards themselves or others.

Physical restraint--holding a patient for over five minutes in order to prevent freedom of movement.

Mechanical restraint--using a device, such as 4-point or full sheet restraint, to restrict a patient's movement (excludes devices prescribed for medical purposes).

Chemical restraint--medicating a patient against her will for the purpose of restraint rather than treatment.

Seclusion--placing a patient alone in a room so that she cannot see or speak with patients or staff and the patient cannot leave or believes she cannot leave."3

She based this decision on her observation of the patient's mental, physical state and level of consciousness. It is common procedure and protocol in facilities for patient's to be released from restraints when the danger of violence is felt to have passed.

"How Long May Restraint Continue?

When an emergency no longer exists, the patient should be released. Thus, staff should release a patient who, upon examination, appears calm. The total time which a patient may be restrained is limited:"3

Later in the shift, the same nurse was helping the patient get up. In the course of this maneuver, the patient fell and claimed that an injury was sustained.

A lawsuit would be filed against the facility alleging negligence on the part of the nurse. The patient contended that the removal of the restraints breached standards of care.

In the initial trial, the jury was instructed to view the nurse's role as an "error in judgement." Based on this and on testimony on the proper use of restraints, standards of care, the court found for the facility.

The patient appealed.

Questions to be answered:

1. Was the nurse in error to remove the restraints from a patient when she felt they were no longer needed.

2. Did the removal of the restraints directly contribute to the "injury" that the patient claimed to sustain?

3. Were the standards of care governing restraint use adequately maintained?

The plaintiff's arguments sought to convince the jury that poor judgement was exercised by the nurse. It was contended that removal of the restraints and ambulation of the patient put him in harm's way.

With the patient assessed to be calm, the purpose of the restraints, "to prevent the patient from harming himself or others," had been achieved.

The purpose of the restraints had not been to "keep the patient from falling out of bed." The removal of the restraints then, could not be deemed as negligent. There was no duty of care breached in allowing the calm patient to remain unrestrained.

The order was in place to ambulate the patient when stable. In the nurse's opinion, the patient was ready. Another nurse may not have agreed with her actions. The patient under a different nurse's care might have been kept in restraints. A nurse could have "held off" on the order to ambulate.

There was no causative relationship between removing the restraints and the patient's fall. In carrying out orders for ambulation, the nurse was providing proper nursing care.

It's not difficult to picture a lone nurse with an unsteady patient losing control and having the patient slip away. Would this be a breach of duty owed to the patient?

One could argue that the nurse had no business trying to move a patient by herself. One might also observe the staffing patterns at the time and realize the nurse was doing "the best she could."

The decision to remove the restraints was clearly a nursing decision. Often the decision to use them in the first place lies with the nurse too.

This illustrates the leeway and discretion given nurses when carrying out physician's orders. It also shows the typical catch 22 situation some nurses may find themselves in regarding restraint use.

"Historically, conventional wisdom supported using physical restraints, including bed side rails, to "protect and safeguard" residents. Ironically, little documented evidence exists that restraints prevent falls and risk of injury from falls. Clinical studies demonstrate that restraints, conversely, in some instances, precipitate or exacerbate fall risk."4

Both nurses in the above situation would be acting within their scope of practice. Each would be adhering to standards of care.

For the plaintiff to have a case, it would need to proven that either the removal of the restraints or the ambulation of the patient was premature.

This was clearly not the case. The actions of the nurse were in good faith and exercised reasonable concern for the well being of the patient. The fact that the patient suffered a fall is unfortunate, and reasonably unforseeable.

It can be compared to the actions of a physician when dealing with an acute patient. Depending on which course of treatment that physician chooses, the patient might or might not have a favorable outcome.

In either case, as long as the physician exercises reasonable judgement based on established principles of practice, a finding of negligence is unlikely.

It has been well established that Medicine is not an exact science. Outcomes are not guaranteed when prescribing courses of treatment.

They are the result of standard medical practices and individual patient responses. These responses are not always predictable. Basically, the caregiver can only hope for the best.

The same principle applies to Nursing care. Regardless of how accurate assessments are and how diligently orders are carried out, patients may or may not experience favorable outcomes.

When outcomes are unfavorable, it is the constitutional right of the patient or patient's estate to sue anyone felt to be involved.

The court reviewed the facts of the case and a nursing expert's testimony on restraint use. The appeals court agreed that standards of care had been maintained.

There exists today intense pressure from family members, governmental agencies and regulatory agencies to limit restraint use to "only when absolutely necessary." As soon as they are put in use, the plan of care must include provisions for their removal.

Link Sections:

Head Injuries:
http://www.nursefriendly.com/nursing/directpatientcare/head.injuries.htm

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Mechanical & Physical Restraints:
http://www.nursefriendly.com/nursing/directpatientcare/mechanical.physical.re...

Medical Legal Consulting Nurse Entrepreneurs
http://www.nursefriendly.com/nursing/ymedlegal.htm

Sources:

1. RRNL 2 (July 1997)

2. Family Caregivers Alliance Clearinghouse. Revised November 1996. Fact Sheet: Head Injury. Retrieved May 30, 1999 from the World Wide Web: http://www.caregiver.org/factsheets/head_injury.html

3. Mental Health Legal Advisors Committee. No date given. Your Rights in Hospitals Regarding Restraining and Seclusion. Retrieved May 30, 1999 from the World Wide Web: http://www.psychiatry.com/mhlac/basicrights/restraintandseclusion.html

4. Braun, Julie A. & Quish, Clare J. 11/10/98. Illinois Institute for Continuing Legal Education. Physical Restraints And Fall-Related Injuries. Retrieved May 30, 1999 from the World Wide Web: http://www.iicle.com/articles/braun11_10_98b.html

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Send comments and mail to Andrew Lopez, RN

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Sincerely,

Andrew Lopez, RN

Nursefriendly, Inc. A New Jersey Corporation.

38 Tattersall Drive, Mantua New Jersey 08051

http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137

856-415-9617, (fax) 415-9618

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InspirationalNursing.com:"InspirationalNursing.com. Touching Poems, and Inspiring stories that touch the heart and occasionally bring a tear to your eye. Affection, Ambition, Angels In Our Lives, Animals, Babies, Bereavement, Caring, Caring, Children, Christian Stories, Christmas, Computers & The Internet, Death, Dependability, Determination, Dying, Easter, Emergency Medical Services (EMS), End of Life, Etc., Friendship, God's Creatures, Grief, Holiday Thoughts, Honesty, Hospice Poems, etc."

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Jocularity.com (Former home to the Journal of Nursing Jocularity (JNJ)):"Nursing & Medical Humor. Find hundreds of jokes and links to sites that will make you smile. Therapeutic Humor Associations, Battle of the Sexes, Bedside Nursing Humor, Brain Teasers, Clowning, Clowns, Therapeutic Humor & Comedy Links, Dental Humor, Emergency Department Humor, General Nursing Humor, Geriatrics, Senior Citizen, etc."

http://www.jocularity.com

Legalnursingconsultant.com:"This website is intended to be a resource for Legal Nurse Consultants, Attorneys looking to use their services, and nurses looking to enter the field of Legal Nurse Consulting. On our site you'll find a directory of LNCs by state and specialty."

http://www.legalnursingconsultant.com

Nursefriendly.com:"Nationwide Nursing Resources: In this Nursing Portal you'll find information on Nursing Jobs, Nursing Schools, Nurse Degrees, LPNs, RNs, APNs, Nursing Associations and much more."

http://www.nursefriendly.com

Nursinga2z.com:"It is our intent for this Alphabetical, A to Z index to be a comprehensive listing (In Progress) of Nursing-related resources on the Internet. It is indexed by Google and fully searchable."

http://www.nursinga2z.com

Nursingdiabetics.com:"Welcome to NursingDiabetics.com. Here you will find information on all aspects of Diabetes, a disease that afflicts millions of people world wide. I'll be adding pages as fast as I can research the information so remember to bookmark this page and return."

http://www.nursingdiabetics.com

Nursingdiscussions.com:"This website will be a portal to Nursing Discussion boards throughout the Web. If your site has a discussion board we don't have listed here, please contact us."

http://www.nursingdiscussions.com

Nursingentrepreneurs.com:"Nationwide Nursing resource to nurse entrepreneurs looking to nework and start home based businesses. On it you will find links to small and large business related resources."

http://www.nursingentrepreneurs.com

Nursinghumor.com:"Nursing & Medical Humor. Find hundreds of jokes and links to sites that will make you smile. Therapeutic Humor Associations, Battle of the Sexes, Bedside Nursing Humor, Brain Teasers, Clowning, Clowns, Therapeutic Humor & Comedy Links, Dental Humor, Emergency Department Humor, General Nursing Humor, Geriatrics, Senior Citizen, etc."

http://www.nursinghumor.com

Sunday, October 30, 2011

(Nursing's) Most Pressing Concerns About #Healthcare @yoganurse @wwwrnorg #nursing #epatients #patients #nursefriendly

New!

I see the most pressing concern in the nursing profession and healthcare is the assurance that the consumer is getting what they are not only paying for, but what they deserve as they put their trust in others to care for them with utmost skill.

Judi S. Brantley, RN BSN MEd. Certified Legal Nurse Consultant, Charleston Medical Legal Consultants, South Carolina Legal Nurse Consultants, Nursing Entrepreneurs, Nurse-Owned Businesses:Charleston Medical Legal Consultants, LLC provides Case Analysis for Medical Malpractice cases. This includes, but not limited to:

  1. Inventory for necessary medical records
  2. Screening for merit
  3. Identify adherences to/deviations from Standards of Care
  4. Medical story
  5. Chronologies with Lexis Nexis CaseMap/TimeMap
  6. Rendering list of potential defendants
  7. Educate in medical questions
  8. Medical Research
  9. Assist in locating expert witnesses
Charleston Medical Legal Consultants, LLC
3575 Maybank Hwy., Suite D192
Johns Island, South Carolina 29455
Email Address: judibrantley@gmail.com
http://www.legalnursingconsultant.com/charleston/

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Your most pressing concerns with the profession and healthcare: The Healthcare crisis in the US with the costs way out of control.

Larry Snyder, BA, RN, DBA, RN.ORG, SA, Nursing Continuing Education Providers:"Larry Snyder, RN is the Founder and President of RN.ORG®, SA. As a licensed healthcare professional with over 15 years of experience in nursing as well as a computer authority with in-excess of 20 years of experience, he is knowledgeable with the integration of healthcare and computers and sees a strong need for licensed professionals to maintain their license in an easy, convenient, comfortable no stress environment. Larry has worked in various aspects of nursing in many states in both large and small hospitals and has the experience and background to make healthcare and nursing education friendly. Larry also functioned as a consulant at large corporations in various aspects of IT management including CBS Sports, Sportsline.com, Sports.com, Universal Studios, Nickelodeon, Viacom, Flexsys and Monsanto. Larry also has served as an expert witness on several high profile cases throughout the United States sharing his valuable input as an experienced Emergency Room nurse."
Latin America Office (Corporate Offices)
Larry Snyder - RN.ORG®, SA
CR 15A # 10A-03
El Poblado, Medellin, Colombia
Hospital Sales (English) USA: 1-954-369-4556
Hospital Sales (EspaƱol - E.E.U.U): 1-860-786-1866
E-mail Address: info@rn.org
Blogs, Social Media (Twitter, Linkedin, Facebook, etc): http://www.facebook.com/MedellinRN
http://www.linkedin.com/pub/dir/Larry/Snyder
http://www.twitter.com/wwwRNorg
Phone number: 954-369-4556
Website: http://www.rn.org
http://www.nursingentrepreneurs.com/snyder/

Categories: Emergency Department Nursing, Nursing Continuing Education, Nursing Education

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Your most pressing concerns with the profession and healthcare: Burn out, low-self esteem, nurses do not realize how powerful they are View previous responses: http://www.nursefriendly.com/concerns/

Annette Tersigni RN, Yoga Nursing®:"I am the founder of Yoga Nurse Medical Yoga and Stress Management and am the creator of the enlightening new field of Yoga Nursing® and the Yoga Nursing Institute. Yoga Nursing is the marriage of modern nursing science with the ancient science of yoga. My programs are endorsed by lots of doctors and health care providers as a safe therapy to decrease pain and suffering and help folks to find peace instead of going to pieces. I have dedicated the past 16 years educating people around the world on leading healthier, spiritual lifestyles and with a dose of tough love and loads of laughter helped them to WAKE UP and GET CONSCIOUS NOW.

I am a sought after no barriers heart felt speaker, coach, teacher and writer and am featured extensively in the media including in the Associated Press and on NBC, CBS, Fox News affiliates and have been interviewed on national TV by Arielle Ford as one of America's Experts. I am producing, writing, and acting in several DVD documentary/educational projects: I am training and coaching other nurses, yoga teachers and health professionals throughout the USA and Canada to be Yoga Nursing Therapists and I lead fantabulous Yoga and Juice fasting Makeover Retreats on the magnificent Pyrate laden Crystal Coast of North Carolina. My programs our hip, conscious, filled with hilarious humor, enlightening and designed to inspire and leave a legacy. This is the most prolific, jamming and juicy time of my life and I get to do it all by serving others. SERVING RULES!"
Street Address: 103 short st apt. E
Beaufort, North Carolina, 28516
E-mail Address: theyoganurse@gmail.com
Phone: 252.725.1924
Facebook: http://www.facebook.com/profile.php?id=629639595&v=info
Homepage Address: http://www.yoganurse.com
http://www.nursingentrepreneurs.com/tersigni

Sincerely,

Andrew Lopez, RN

Nursefriendly, Inc. A New Jersey Corporation.

38 Tattersall Drive, Mantua New Jersey 08051

http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137

856-415-9617, (fax) 415-9618

Visit our network of sites. Over 150,000 + Nurse Selected, Approved Nursing & Healthcare Resources:

For Health Information you can use, Follow, Connect, Like us on Facebook, Google +, LinkedIN, Twitter, StumbleUpon (Most Invites Accepted):

http://www.nursefriendly.com/social/

4nursing.com:"In this Nursing Portal you'll find information on Nursing Jobs, Nursing Schools, Nurse Degrees, CNAs, LPNs, RNs, Travel Nursing, Prescriptions Drugs, Medications, Nursing Associations and much more."

http://www.4nursing.com

InspirationalNursing.com:"InspirationalNursing.com. Touching Poems, and Inspiring stories that touch the heart and occasionally bring a tear to your eye. Affection, Ambition, Angels In Our Lives, Animals, Babies, Bereavement, Caring, Caring, Children, Christian Stories, Christmas, Computers & The Internet, Death, Dependability, Determination, Dying, Easter, Emergency Medical Services (EMS), End of Life, Etc., Friendship, God's Creatures, Grief, Holiday Thoughts, Honesty, Hospice Poems, etc."

http://www.inspirationalnursing.com

Jocularity.com (Former home to the Journal of Nursing Jocularity (JNJ)):"Nursing & Medical Humor. Find hundreds of jokes and links to sites that will make you smile. Therapeutic Humor Associations, Battle of the Sexes, Bedside Nursing Humor, Brain Teasers, Clowning, Clowns, Therapeutic Humor & Comedy Links, Dental Humor, Emergency Department Humor, General Nursing Humor, Geriatrics, Senior Citizen, etc."

http://www.jocularity.com

Legalnursingconsultant.com:"This website is intended to be a resource for Legal Nurse Consultants, Attorneys looking to use their services, and nurses looking to enter the field of Legal Nurse Consulting. On our site you'll find a directory of LNCs by state and specialty."

http://www.legalnursingconsultant.com

Nursefriendly.com:"Nationwide Nursing Resources: In this Nursing Portal you'll find information on Nursing Jobs, Nursing Schools, Nurse Degrees, LPNs, RNs, APNs, Nursing Associations and much more."

http://www.nursefriendly.com

Nursinga2z.com:"It is our intent for this Alphabetical, A to Z index to be a comprehensive listing (In Progress) of Nursing-related resources on the Internet. It is indexed by Google and fully searchable."

http://www.nursinga2z.com

Nursingdiabetics.com:"Welcome to NursingDiabetics.com. Here you will find information on all aspects of Diabetes, a disease that afflicts millions of people world wide. I'll be adding pages as fast as I can research the information so remember to bookmark this page and return."

http://www.nursingdiabetics.com

Nursingdiscussions.com:"This website will be a portal to Nursing Discussion boards throughout the Web. If your site has a discussion board we don't have listed here, please contact us."

http://www.nursingdiscussions.com

Nursingentrepreneurs.com:"Nationwide Nursing resource to nurse entrepreneurs looking to nework and start home based businesses. On it you will find links to small and large business related resources."

http://www.nursingentrepreneurs.com

Nursinghumor.com:"Nursing & Medical Humor. Find hundreds of jokes and links to sites that will make you smile. Therapeutic Humor Associations, Battle of the Sexes, Bedside Nursing Humor, Brain Teasers, Clowning, Clowns, Therapeutic Humor & Comedy Links, Dental Humor, Emergency Department Humor, General Nursing Humor, Geriatrics, Senior Citizen, etc."

http://www.nursinghumor.com

Friday, July 8, 2011

When Nurse Make Mistakes (Theresa Brown, RN) - NYTimes.com

This year, a Seattle nurse named Kim Hiatt committed suicide. Ms. Hiatt’s death came nearly seven months after she had given an unintended overdose to an infant heart patient, a medical error that was said to have contributed to the child’s death days later.

Ms. Hiatt had been a nurse for 27 years and had often cared for the 8-month-old girl during the child’s stay in the pediatric intensive care unit of her hospital. She had probably drawn up the right dose of the drug hundreds of times in her career. But once, she made a life-changing error. A baby died, and she was suspended, then fired from a profession she loved. And now she’s dead.

Please click on the "VIA" link to read the full article.

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******************************************************

Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

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Friday, April 29, 2011

Nurses Long Work Hours, Scheduling Can Increase Patient Mortality

A new study has found that patient deaths from pneumonia and acute myocardial infarction were significantly more likely in hospitals where nurses reported schedules with long work hours. The finding was just one of several revelations from a study of nurses' work schedules, patient outcomes, and staffing led by University of Maryland School of Nursing researchers in collaboration with researchers at the Johns Hopkins University School of Medicine.

The study is the latest in ongoing research on nurse scheduling and staffing funded by the National Council of State Boards of Nursing. In the current study, Alison Trinkoff, ScD, MPH, RN, FAAN, professor at the School, and co-authors Meg Johantgen, PhD, RN; Carla Storr, PhD, MPH, RN; Yulan Liang, PhD; Ayse Gurses, PhD;and Kihye Han, MD, RN shifted their focus from the effects on nurses in previous studies to patient well-being.

The team linked patient outcome and staffing information from 71 acute-care hospitals in two representative states (Illinois and North Carolina) with the survey responses of 633 randomly selected nurses who worked in these hospitals. Their findings are published in "Nurses' Work Schedule Characteristics, Nurse Staffing, and Patient Mortality," in the January/February issue of the journal Nursing Research. Most U.S. hospitals use 12-hour nursing shifts exclusively, as opposed to eight-hour shifts, a trend begun during nursing shortages nationwide in the 1980s. "Although many nurses like these schedules because of the compressed nature of the workweek, the long schedule?as well as shift work in general?lead to sleep deprivation," says Trinkoff.

Click on the "via" link for the full article.

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******************************************************

Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

150,000 + Nurse-Reviewed & Approved Nursing Links

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