Showing posts with label Traumatic Brain Injury. Show all posts
Showing posts with label Traumatic Brain Injury. Show all posts

Wednesday, April 20, 2011

UA, Fire Departments, State, Take on Brain Injury | UANews.org

With 1.4 million victims of traumatic brain injury, or TBI, reported annually in the U.S., the University of Arizona, the Arizona Department of Health Services and local fire department/Emergency Medical Services, or EMS, responders throughout Arizona will be implementing the most comprehensive 911 system "attack" on TBI ever attempted. 

The Arizona Emergency Medicine Research Center at the UA College of Medicine-Phoenix and the Arizona Department of Health Services on Wednesday, April 20 announced the Excellence in Prehospital Injury Care project that will bring first responders, the state health department and university researchers together to improve brain injury treatment in EMS systems throughout the state.

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Wednesday, March 2, 2011

Patient Left Unrestrained, Patient Injured. Nurses Judgement Call

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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

Created on Saturday May 23, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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Saturday, February 19, 2011

Traumatic Brain Injury, Legal Nurse Consulting, Law Resources

Legal Nurse Consultants specializing in Traumatic Brain Injury Issues:

Louise Cardillo, R.N. B.S., Cardillo Consultants:"Legal Nurse Consulting firm for ten years. I am a strong liason between attorney's, clients and experts. The strength of all cases is in meticulous attention to detail of medical records and choosing the appropriate expert. This aspect of consulting will bring your cases to closure with damages often above expectation. Experience in this field is critical to the success of working with a Legal Nurse Consultant. In addition, the nurse must have a strong clinical foundation and education.
1190 Honeoye Falls 5 Points Rd.
Honeoye Falls, New York 14472
E-Mail: louLNC@frontiernet.net
http://www.nursingexperts.com/cardillo/

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Brain Injury Association of America:"The Brain Injury Association of America was founded in 1980 by a group of individuals who wanted to improve the quality of life for their family members who had sustained brain injuries. Despite phenomenal growth over the past two decades, the Association remains committed to its grassroots. The Brain Injury Association of America encompasses a national network of more than 40 Chartered state affiliates across the country as well as hundreds of local chapters and support groups. By acting as a clearinghouse of community service information and resources, participating in legislative advocacy, facilitating prevention awareness, hosting educational programs and encouraging research, the Brain Injury Association of America and its affiliates reach the millions of individuals living with the "silent epidemic" of brain injury."
105 North Alfred Street, Alexandria, VA 22314
703-236-6000, fax 703-236-6001
FamilyHelpline@biausa.org
http://www.biausa.org/

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Brain Injury Information Page:"The Brain Injury Information Page provides information about brain injury, concussion, coma and head injury, for TBI survivors, spouses and caregivers. Our goal is to provide education and assistance with the process of diagnosis and proof of brain injury, sometimes called head injury. This page features articles, information and graphics about traumatic brain injury. Our View of Advocacy: We of the Brain Injury Law Group make our living as advocates. But advocacy implies more than being a lawyer. It means dedicating oneself to the community we serve - the survivor, the family member of the survivor, the medical professional. To that end, we have created this home page, to provide information, resources and links, to help you learn and solve the problems you face."
http://tbilaw.com/

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Florida Institute for Neurologic Rehabilitation, Inc. (FINR):"Brain injury and head injury rehabilitation information and resources from The Florida Institute for Neurologic Rehabilitation. FINR helps Brain injury survivors, both children and adult. The Florida Institute for Neurologic Rehabilitation, Inc. (FINR) is dedicated to excellence in the provision of rehabilitation, education and vocational services to both children and adult survivors of brain injury. Through the provision of individualized assessment, restorative service and foundational retraining in behavior, psych-social, cognitive, physical functioning, communication, daily living, education and vocational area, FINR seeks to assist its clients in attaining their maximum level of functioning and quality of life in the most normalized and least restrictive environment."
http://www.finr.net/

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Traumatic Brain Injury Information Page, National Institute of Neurological Disorders and Stroke (NINDS):"Traumatic brain injury (TBI) occurs when a sudden physical assault on the head causes damage to the brain. The damage can be focal, confined to one area of the brain, or diffuse, involving more than one area of the brain. TBI can result from a closed head injury or a penetrating head injury. A closed head injury occurs when the head suddenly and violently hits an object, but the object does not break through the skull. A penetrating head injury occurs when an object pierces the skull and enters the brain tissue. Several types of traumatic injuries can affect the head and brain. A skull fracture occurs when the bone of the skull cracks or breaks. A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain. This can cause bruising of the brain tissue, called a contusion. A contusion can also occur in response to shaking of the brain within the confines of the skull, an injury called "countrecoup." Shaken baby syndrome is a severe form of head injury that occurs when a baby is shaken forcibly enough to cause extreme countrecoup injury. Damage to a major blood vessel within the head can cause a hematoma, or heavy bleeding into or around the brain. The severity of a TBI can range from a mild concussion to the extremes of coma or even death. A coma is a profound or deep state of unconsciousness. Symptoms of a TBI may include headache, nausea, confusion or other cognitive problems, a change in personality, depression, irritability, and other emotional and behavioral problems. Some people may have seizures as a result of a TBI."
http://www.ninds.nih.gov/health_and_medical/disorders/tbi_doc.htm

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National Resource Center for Traumatic Brain Injury:"The mission of the National Resource Center for Traumatic Brain Injury is to provide relevant, practical information for professionals, persons with brain injury, and family members. Many of our products were developed by nationally recognized experts. We have more than 20 years of experience developing intervention programs, assessment tools, and investigating the special needs and problems of people with brain injury and their families."
Virginia Commonwealth University's Medical College of Virginia
http://www.neuro.pmr.vcu.edu/

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The Perspectives Network, Inc.:"The Perspectives Network, Inc.'s primary focus is positive communication between persons with brain injury, family members/ caregivers/friends of persons with brain injury, those many professionals who treat persons with brain injury and community members in order to create positive changes and enhance public awareness and knowledge of acquired/traumatic brain injury."
Mailing Address: P. O. Box 121012, W. Melbourne FL 32912-1012
E-Mail Address: TPN@tbi.org
http://www.tbi.org/

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Rehabilitation Research Center (RRC) for Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI):"The Rehabilitation Research Center (RRC) for Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) conducts research to better understand and improve outcomes after TBI and SCI. Outcomes studied include the functional, vocational, and life satisfaction areas that are important to people with and without disabilities."
Rehabilitation Research Center for TBI & SCI 950 South Bascom Avenue, Suite 2011 San Jose, CA 95128 San Jose, California
phone number is 408/295-9896 Fax the RRC at 408/295-9913, tbisci@tbi-sci.org
http://www.tbi-sci.org/

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TBIchat.org:"Homepage for brain injury survivors & caregivers with pictures, stories, poems, art gallery, message board, question of the week board, homepages, & email lists."
http://www.braininjurychat.org/

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Traumatic Brain Injury LawyerShop:"Traumatic Brain Injury Lawyer Shop is a resource that allows you to find information from lawyers in your area who provide legal services pertaining to traumatic brain injury, TBI, closed head injury, concussion, and coma. While most legal directories offer some information about traumatic brain injury and TBI, the most valuable information comes from an attorney or lawyer who has experience involving traumatic brain injury lawsuits, coma lawsuits, concussion lawsuits or closed head injury lawsuits."
http://www.tbilawyershop.com/

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Traumatic Brain Injury National Data Center (TBINDC):"The Traumatic Brain Injury National Data Center (TBINDC) at Kessler Medical Rehabilitation Research and Education Center is the coordinating center for the research and dissemination efforts of the Traumatic Brain Injury Model Systems (TBIMS) program funded by the National Institute on Disability and Rehabilitation Research (NIDRR). The TBI Model Systems consist of 17 comprehensive systems of care distributed throughout the United States that conduct innovative research and provide “model” care to persons who experience traumatic brain injury. The TBIMS program seeks to improve the lives of persons who experience traumatic brain injury, their families and their communities by creating and disseminating new knowledge about the course, treatment and outcomes relating to their condition."
Traumatic Brain Injury National Data Center c/o Kessler Medical Rehabilitation Research and Education Corp.
1199 Pleasant Valley Way West Orange, NJ 07052
http://www.tbindc.org/

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Prepaid Legal Services: There are many matters that you encounter on a daily basis which have a legal aspect, for instance, motor vehicle accidents and other types of injury claims, estate planning, probate and estate administration, matters pertaining to employment, sale or purchase of real estate, consumer transactions, auto repairs and sales, family and juvenile law, landlord/tenant issues, insurance matters, business, bankruptcy, tax and workers compensation. Literally, everything we do today touches upon the law in one way or another. With Prepaid Legal, you'll receive unlimited phone conversation/consultations on any legal matter at no additional cost.

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See also:

MedMal Consulting:'MedMal Consulting is a Physician owned and operated full-service medical malpractice evaluation and medical negligence consulting support firm. MedMal Consulting has doctors, legal nurse consultants, and medical legal litigation support personnel to assist with every aspect of your medical negligence case. Established in 1992, Dr. Herman and MedMal Consulting have over 18 years of experience in the medical legal field and have assisted in obtaining more than $147 million dollars in verdicts and settlements in medical malpractice cases."
MedMal Consulting, Inc.
P.O Box 391153
Cleveland, Ohio 44139
Phone: (216) 744-8907
Fax:(440) 248-8257
eMail: info@medmalconsulting.com
http://www.medmalconsulting.com/

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Send comments and mail to Andrew Lopez, RN

Last updated by Andrew Lopez, RN on Monday, December 6, 2010

Click on the "via" link to read the rest of the article.

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Any questions, please drop me a line.

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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

http://www.4nursing.com
http://www.legalnursingconsultant.com
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http://www.nursingcasestudy.com
http://www.nursingentrepreneurs.com
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