RM AP1
All the information is attached below. follow it completely.
Nurses and Medical Malpractice
Presented by NSO and CNA
Medical malpractice claims can be asserted against any healthcare provider, including nurses. Although theremay be a perception that physicians are held responsible for the majority of lawsuits, the reality is that nurses
are more frequently finding themselves defending the care they provide to patients. In fact, over $83 million was paid
for malpractice claims involving nursing professionals, according to the most recent CNA HealthPro 5-year study*.
Settlement: $250,000 Legal Expenses: $14,139
Note: There were multiple co-defendants in this claim who
are not discussed in this scenario. While there may have been
errors/negligent acts on the part of other defendants, the case,
comments, and recommendations are limited to the actions of
the defendant; the nurse.
The decedent/ plaintiff was a 67-year-old male who underwent
a right total knee replacement. Following the procedure, the
plaintiff was treated in the post-anesthesia care unit where an
epidural catheter was inserted for post operative pain
management.
Following one episode of hypotension which was treated
successfully with ephedrine, the plaintiff was discharged to an
inpatient medical-surgical care nursing unit with the epidural
in place. Although the defendant nurse customarily worked on
the post-acute critical care unit, she had been re-assigned to
the medical-surgical nursing care unit. The defendant nurse
stated that she understood her assignment at the time of the
plaintiffs admission to this unit was to provide oversight of the
patient care on the entire floor for that shift.
The defendant nurse assessed the plaintiff upon his admission
to the unit and found him to be stable. The defendant nurse
understood that the direct care of the plaintiff was assigned to
a co-defendant licensed practical nurse (LPN).
Approximately three hours after arriving on the unit, the
plaintiff was unable to tolerate ordered respiratory therapy due
to nausea and vomited shortly thereafter. According to the
defendant nurse, approximately ten minutes after the episode
of vomiting, the LPN found the plaintiff cyanotic and
unresponsive and immediately called a code.
The defendant nurse responded, as did the code team, and the
plaintiff was intubated and transferred to ICU. This account
of events was disputed by the LPN and two other staff on the
unit who understood that the defendant nurse was responsible
for the direct care of the plaintiff.
The LPN stated that it was the defendant nurse who found the
plaintiff to be unresponsive at some point after the episode of
vomiting and called the code herself. The elapsed time
between the episode of vomiting and the code is also disputed.
The eventual diagnosis was anoxic encephalopathy due to the
time that elapsed before CPR was initiated. The prognosis was
poor and life support was withdrawn. The plaintiff breathed
independently and was transferred to hospice care where he
subsequently expired.
Ordered vital signs and checks of the xyphoid process were not
documented. The fact that the plaintiff had experienced
hypotension in the recovery room should have warranted even
closer observation. The episode of nausea and vomiting should
have resulted in additional observation and notice to the
physician.
C A S E S T U D Y W I T H R I S K M A N A G E M E N T S T R AT E G I E S
Case Study: Failure to adequately assess and monitor the patient post
operatively resulting in the patients death
Resolution
Experts determined that the defendant nurse had breached the standard of care in the following areas, including:
Failure to formally clarify her work assignment
Failure to properly assess the plaintiff upon his admission to the medical-surgical care nursing unit
Failure to properly supervise the LPNs care of an unstable patient
Failure to follow physician post operative care orders
Failure to notify the physician of changes in the plaintiff s condition
Failure to initiate CPR immediately upon finding the plaintiff to be unresponsive
Given the departures from the standard of care and the pejorative testimony of other staff members regarding the defendant
nurses care, the decision was made to settle the case on behalf of the defendant nurse. The case was settled for $250,000 with an
additional $14,139 paid in legal expenses.
There is some question whether the patient was, in fact, stable when discharged from the PACU and admitted to the medical-
surgical care nursing unit. There may have been miscommunication among the nursing staff as the defendant nurse did not
usually work on the unit where this event occurred. In addition, the defendant nurse seemingly misunderstood both her
assignment, as well as the assignment of the LPN.
Each staff member is responsible to ensure clarity regarding their direct care patient assignments, as well as any
supervisory or monitoring duties that are assigned. Clearly document assignments at the start of the shift and include
and communicate any modifications to the assignment during the shift. This is even more critical when staff typically
assigned to other areas is floated to the unit.
Fully assess patients upon admission to the unit and notify the physician if any patient is deemed unstable or if care
and monitoring is required beyond that which is provided on the medical-surgical care nursing unit. Provide the
physician with the patients specific clinical signs and symptoms.
Timely and completely carry out physician orders. Perform and document all ordered monitoring and treatment and
notify the charge nurse and physician of any orders that could not be carried out due to patient condition or refusal of care.
Timely notify the attending physician of any significant changes in the patients condition.
Risk Management Recommendations
*CNA HealthPro Understanding Nurse Liability, 2006-2010: A Three-part Approach, CNA Insurance Company, November 2011. To read the complete study visit www.nso.com/nurseclaimreport2011
This publication is for educational purposes. It is not legal, professional or medical advice. CNA makes no representations as to its correctness or completeness and accepts no liability for any
injury or damage that may arise from its use. Specific legal or medical questions should be referred to a competent attorney or medical professional before applying this material in any particular
factual situations. This material may address and discuss matters for which your policy does not provide coverage, and the material does not create or imply the existence of coverage. Please
consult your insurance policy for the specific terms, coverages, amounts, conditions and exclusions of coverage. All products and services may not be available in all states and may be subject to
change without notice. CNA policies are underwritten by the property/casualty companies of CNA, Chicago, IL. CNA is a registered trademark of CNA Financial Corporation. 2012 Continental
Casualty Company. All rights reserved.
This publication is intended to inform Affinity Insurance Services, Inc., customers of potential liability in their practice. It reflects general principles only. It is not intended to offer legal advice or to
establish appropriate or acceptable standards of professional conduct. Readers should consult with a lawyer if they have specific concerns. Neither Affinity Insurance Services, Inc., NSO, nor CNA
assumes any liability for how this information is applied in practice or for the accuracy of this information. This publication is published by Affinity Insurance Services, Inc., with headquarters at 159
East County Line Road, Hatboro, PA 19040-1218. Phone: (215) 773-4600. All world rights reserved. Reproduction without permission is prohibited.
Nurses Service Organization is a registered trade name of Affinity Insurance Services, Inc.; (AR 244489); in CA, MN & OK, AIS Affinity Insurance Agency, Inc. (CA 0795465); in CA, Aon Affinity
Insurance Services, Inc., (0G94493), Aon Direct Insurance Administrator and Berkely Insurance Agency and in NY and NH, AIS Affinity Insurance Agency. 2012 Affinity Insurance Services, Inc.
X-8540-0112
Risk Management is an integral part of a healthcare professionals standard business practice. Risk management activities include
identifying and evaluating risks, followed by implementing the most advantageous methods of reducing or eliminating these
risks A good Risk Management Plan will help you perform these steps quickly and easily!
Visit www.nso.com/riskplan to access the Risk Management plan created by NSO and CNA. We encourage you to use this as a
guide to develop your own risk management plan to meet the specific needs of your healthcare practice.
Guide to Sample Risk Management Plan RM AP 1
You will be assigned one case study to work on individually for the length of this course. As you learn new material in each subsequent unit, you will reflect upon the case study in greater depth. Evolving discussions are expected to incorporate new learning from each unit (and how it applies to the same case study).There are 4 portions to the Active Participation (Case Study) assignment- each portion is worth 50 points. See syllabus addendum for assignment details and grading rubrics.
CASE STUDY #3 IS ATTACHED TO THIS POST!!!!
Assignment Objective: To engage in scholarly dialogue with peers.
Evaluation of your class participation by the professor will be based on the following criteria:
Raising and answering questions related to the assigned readings
Sharing ideas, insights and feelings; sharing personal experiences and observations
Pointing out relevant data; relating and synthesizing others’ ideas in a respectful, thoughtful and nurturing way
Providing constructive feedback on the learning climate and processes of the course
Pointing out relationships to earlier discussions; helping others develop their ideas
Citing your references to the contributions of others
As you learn new material in each subsequent unit, you will reflect upon the case study in greater depth. Evolving discussions are expected to incorporate new learning from each unit (and how it applies to the case study). There are 4 portions to the Active Participation assignment; each portion is worth 10 points.
Everyoneis expected to add the actual pdf and an APA citation of a journal article that advances the case study discussions.
Acceptable scholarly journals include:
MGMA Connection
British Journal of Healthcare Management
Journal of Healthcare Compliance
Journal of Health Care Law and Policy
The Journal of Law, Medicine, & Ethics
Journal of Healthcare Management
International Journal of Healthcare Management
BMC Medical Ethics
Risk Management and Healthcare Policy
You must have an initial post (covering your analysis of the case). This post must be at least 2-3 full paragraphs and include at least 1 journal article and citation in APA format.
Evaluation for Active Participation for Online Class
Points Possible
Posts thoughtful post of required length, with appropriate article (and APA citation) by posted deadline
25
Posts thoughtful post of required length, but does not include appropriate article (and APA citation) by posted deadline
15
Posts appropriate article (and APA citation) by posted deadline, but does not participate in robust discussion
10
Does not post discussion or appropriate article
0
