Analyze the case in terms of the decision-making models from Chapter 9 and answer the following questions (4 paragraphs) Compose your paper in MS Word.

Read Carolyn’s Story, below.
Analyze the case in terms of the decision-making models from Chapter 9 and answer the following questions (4 paragraphs) Compose your paper in MS Word.
What model for decision making was used in Carolyn’s case?
What are the advantages and disadvantages of this model?
Consider all of the decision-making models in Tables 9-1 and 9-2 and select one that you feel would have resulted in a successful treatment outcome. Provide your rationale.
Analyze the case in terms of the competencies for team leaders outlined in Chapter 8, Tables 8-2 and 8-3, and answer the following questions (2 paragraphs):
What would be the first steps a leader would have taken in enabling a team approach to Carolyn’s care?
What steps should a leader have taken to develop Carolyn’s healthcare team?
Case Study: Carolyn’s Story
On 10 April 2001, Caroline, aged 37, was admitted to a city hospital and gave birth to her third child in an uncomplicated caesarean delivery. Dr A was the obstetrician and Dr B was the anaesthetist who set the epidural catheter. On 11 April, Caroline reported that she felt a sharp pain
in her spine and on the night before the epidural was removed she accidentally bumped the epidural site. During this time, Caroline repeatedly complained of pain and tenderness in the lumbar region. The anaesthetist, Dr B, examined her and diagnosed “muscular” pain. Still in pain and limping, Caroline was discharged (transferred) from the city hospital on 17 April. For the next seven days Caroline remained at her home in the country. She telephoned her obstetrician, Dr A, about her fever, shaking, intense low back pain and headaches. On 24 April, the local medical officer, Dr C, examined Caroline and her baby and recommended they both be admitted to the district hospital for back pain and jaundice, respectively.
The admitting doctor at the district hospital, Dr D, recorded that Caroline’s back pain appeared to be situated at the S1 joint rather than at the epidural site. On 26 April, the baby’s jaundice had improved, but Caroline had not yet been seen by the general practitioner, Dr E, who admitted he had forgotten about her. The medical registrar, Dr F, examined Caroline and diagnosed sacroiliitis. He discharged her with prescriptions for oxycodone, paracetamol and diclofenac. He also informed Caroline’s obstetrician, Dr A, of his diagnosis. Caroline’s pain was assisted by the medications until 2 May when her condition deteriorated. Her husband then took Caroline, who was in a delirious state, to the local country hospital. Shortly after arriving at the hospital on 3 May she started convulsing and mumbling incoherently. The local medical officer, Dr C, recorded in the medical records: “excessive opiate usage, sacroiliitis.”
Her condition was critical by this stage and she was rushed by ambulance to the district hospital. By the time she arrived at the district hospital, Caroline was unresponsive and needing intubation. Her pupils were noted to be dilated and fixed. Her condition did not improve and on 4 May she was transferred by ambulance to a second city hospital. At 13:30 on Saturday, 5 May, she was determined to have no brain function and life support was withdrawn.
A postmortem examination revealed an epidural abscess and meningitis involving the spinal cord from the lumbar region to the base of the brain with cultures revealing a methicillin-resistant staphylococcus aureus (MRSA) infection. Changes to the liver, heart and spleen were consistent with a diagnosis of septicaemia. The coronial investigation concluded that Caroline’s abscess could and should have been diagnosed earlier than it was.
The following discussion of the coroner’s report into the death of Caroline highlights many of the issues addressed in the topics outlined in this Curriculum Guide. The observation that surfaced again and again in this story was the inadequacy in recording detailed and contemporaneous clinical notes and the regular incidence of notes being lost. The anesthetist, Dr B, was so concerned about Caroline’s unusual pain that he consulted the medical library, but he did not record this in her clinical notes. He also failed to communicate the risk of what he now thought to be “neuropathic” pain to Caroline or ensure that she was fully investigated before being discharged. There were also concerns that evidence-based guidelines were not followed with respect to Dr B scrubbing prior to the epidural insertion as it was the view of an independent expert that the bacteria that caused the abscess was most likely to have originated from the staff or environment at the city hospital. It was clear that Caroline would be managed by others after her discharge; however, she was not involved as a partner in her health care by being given instructions about the need to seek medical attention if her back pain worsened. Similarly, no referral letter or phone call was made to her local medical officer, Dr C.
It was the coroner’s opinion that each of the doctors who examined Caroline after she returned to the country was hasty in reaching a diagnosis, mistakenly believing that any major problem would be picked up by someone else down the track. Her local medical officer, Dr C, only made a very cursory examination of Caroline as he knew she was being admitted to the district hospital. The admitting doctor, Dr. D, though there was a 30% chance of Caroline having an epidural abscess but did not record it in the notes because he believed it was obvious. In a major departure from accepted medical practice, Dr. E agreed to see Caroline and simply forgot about it.
The last doctor to examine Caroline at the district hospital was the medical registrar, Dr F, who discharged her with prescriptions for strong analgesics without fully investigating his provisional diagnosis of sacroiliitis, which he thought could have been postoperative or infective. With regards to medicating safely, Dr F’s handwritten notes to Caroline were considered vague and ambiguous in instructing her to increase the dose of oxycodone if the pain increased, while at the same time monitoring specific changes. The notes Dr F made on a piece of paper detailing his examination and the possible need for magnetic resonance imaging (MRI) were never found.
The one doctor who the coroner believed could have taken global responsibility for Caroline’s care was her obstetrician, Dr A. He was phoned at least three times after her discharge from the city hospital with reports of her continuing pain and problems, but failed to realize the seriousness of her condition. From the birth of her child to her death 25 days later, Caroline was admitted to four different hospitals and there was a need for proper continuity of care in the handover of responsibilities from each set of medical and nursing staff to another. The failure to keep adequate notes with provisional/differential diagnoses and investigations and provide discharge summaries and referrals led to a delay in the diagnosis of a life-threatening abscess and ultimately Caroline’s death.