Application of Standards of Care: Your instructor has placed you in groups and assigned a case study for the Unit 7 group Project. Look at the legal malpractice case study that has been assigned to your group. Describe the case and discuss the standard of care that the parties will be held to in this case. How will the standards of care and the Nurse Practice Act be applied in a court of law if the case is sued?
Peer review at least two colleagues’ posts and try to review students that do not have feedback. Use Chapter 16, Effective Peer Reviews, in the Kaplan Guide to Successful Writing Handbook as a guide to review.


Malpractice Action Brought by Yolanda Pinnelas case study exhibits several cases of malpractices mainly attributed to staff burnout brought about heavy workload, as a result of poor nurse-patient ratio. Some nurses lack malpractice insurance, there is improper documentation of equipment/pump used on the patient to allow follow-up, despite no evidence of the chemo drug going into the tissue of patient, the nurse records infiltration to IV (wrong documentation).

General standards of care in nursing present general guidelines regarding what a nurse is expected to do or not do as per professional capacity. They express what a prudent and reasonable nurse ought to do and seek to help nurses offer competent, ethical and safe care. In case sued, all nurses involved may be found liable for negligence. The standards of care that apply in this case regard failure to proper documentation, failure for the nurses to respond to beeping and inform the nurse caring for the patient, failure to keep monitoring assessing the patient, and failure to place the IV pump correctly, cross-examining it to ensure that it is well placed (Townsend & Anderson, 2013). .This also goes for failure to give medicine at the right time. As per American Nursing Association, nurses are responsible for maintaining patient safety. They must employ professional judgment in determining the impact of their fatigue on performance, which may vary across individuals; in case this may compromise their practice, they must refrain from practicing. Nonetheless, it seems that despite this, nurses in the case continue practicing in a manner that compromising patient safety, hence unable to comply with standards of practice. The nurses in charge are expected to discuss the impact of fatigue with the management to come up with innovative solutions (American Nurses Association, 2015). 

The Nursing Practice Act determines legal parameters within which to practice nursing, based on specialty, education level and other factors. In this case, when sued, focus would be assessing whether all nurses complied with the act; operated within their scope of specialty, licensing and level of education. Disciplinary measures noted under the act will be imposed and this may extend to parting with monetary compensation and revocation of license. For instance, Florida Nursing Practice Act takes disciplinary actions in nurses who are unable to practice using reasonable safety and skill, as is the case of nurses in the case study, due to any physical/mental condition (fatigue). This also goes for disciplinary measures for those that fail to meet minimally accepts nursing standards, as is the case, of monitoring patient when alarmed by beeping and communicating effectively to inform those in charge. Under the act, all ARNPs must have malpractice insurance or documentation of being documented from it, thus a factor that courses must consider to determine the premise under which they got their licenses and jobs (Florida Board of Nursing, 2016).

References

American Nurses Association. (2015). Scope of practice. Retrieved from http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses/Scope-of-Practice-2

Florida Board of Nursing. (2016). Nurse Practice Act: Chapter 464 Florida Statutes. Retrieved from https://phsc.edu/sites/default/files/program/files/Nurse-Practice-Act.pdf

Townsend, T., & Anderson, P. (2013). Are extended work hours worth the risk? American Nurse Today, 8 (5), n. p.

People involved in case:

Yolanda Pinnelas — patient

Betty DePalma, RN, MS — nursing supervisor

Elizabeth Adelman, RN — recovery room nurse

William Brady, M.D. — plastic surgeon

Mary Jones, RN — IV insertion

Carol Price, LPN

Jeffery Chambers, RN — staff nurse

Patricia Peters, PharmD — pharmacy

Diana Smith, RN

Susan Post, JD — risk manager

Amy Green — quality assurance

Michael Parks, RN, MS, CNS — education coordinator

SAFE-INFUSE — pump

Brand X infusion — pump

Caring Memorial Hospital

Facts:

The patient, Yolanda Pinellas, is a 21-year-old female admitted to Caring Memorial Hospital for chemotherapy. Caring Memorial is a hospital in upstate New York. Yolanda was a student at Ithaca College and studying to be a music conductor.

Yolanda was diagnosed with anal cancer and was to receive Mitomycin for her chemotherapy. Mary Jones, RN, inserted the IV on the day shift around 1300, and the patient, Yolanda, was to have Mitomycin administered through the IV. An infusion machine was used for the delivery. The Mitomycin was hung by Jeffery Chambers, RN, and he was assigned to Yolanda. The unit had several very sick patients and was short staffed. Jeffery had worked a double shift the day before and had to double back to cover the evening shift. He was able to go home between shifts and had about 6 hours of sleep before returning. The pharmacy was late in delivering the drug so it was not hung until the evening shift. Patricia Peters, PharmD, brought the chemotherapy to the unit.

On the evening shift, Carol Price, LPN, heard the infusion pump beep several times. She had ignored it as she thought someone else was caring for the patient. Diana Smith, RN, was also working the shift and had heard the pump beep several times. She mentioned it to Jeffery. She did not go into the room until about 45 minutes later. The patient testified that a nurse came in and pressed some buttons and the pump stopped beeping. She was groggy and not sure who the nurse was or what was done.

Diana Smith responded to the patient’s call bell and found the IV had been dislodged from the patient's vein. There was no evidence that the Mitomycin had gone into the patient's tissue. Diana immediately stopped the IV, notified the physician, and provided care to the hand. The documentation in the medical record indicates that there was an infiltration to the IV.

The hospital was testing a new IV infusion pump called SAFE-INFUSE. The supervisory nurse was Betty DePalma, RN. Betty took the pump off the unit. No one made note of the pump’s serial number as there were six in the hospital being used. There was also another brand of pumps being used in the hospital. It was called Brand X infusion pump. Betty did not note the name of the pump or serial number. The pump was not isolated or sent to maintenance and eventually the hospital decided not to use SAFE-INFUSE so the loaners were sent back to the company.

Betty and Dr. William Brady are the only ones that carry malpractice insurance. The hospital also has malpractice insurance.

Two weeks after the event, the patient developed necrosis of the hand and required multiple surgical procedures, skin grafting, and reconstruction. She had permanent loss of function and deformity in her third, fourth, and fifth fingers. The claimant is alleging that, because of this, she is no longer able to perform as a conductor, for which she was studying.

During the procedure for the skin grafting, the plastic surgeon, Dr. William Brady, used a dermatome that resulted in uneven harvesting of tissue and further scarring in the patient's thigh area where the skin was harvested.

The risk manager is Susan Post, JD, who works in collaboration with the quality assurance director Amy Green. Amy had noted when doing chart reviews over the last 3 months prior to this incident that there were issues of short staffing and that many nurses were working double shifts, evenings, and nights then coming back and working the evening shift. She was in the process of collecting data from the different units on this observation. She also noted a pattern of using float nurses to several units. Prior to this incident, the clinical nurse specialist, Michael Parks, RN, MS, CNS, was consulting with Susan Post and Amy Green about the status of staff education on this unit and what types of resources and training was needed.

Things to remember:

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