FAILURE TO MONITOR POST-SURGICAL PATIENT (QW11)

Failure to Monitor Post-surgical Patient (qw11) - Nursing
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Read the case study attached. Instructions: After reading case study, please write a paragraph depicting which were the most important failures that led to the near death event of the patient? What did you think was the most important contributor of all? APA styleHISTORICAL CASE STUDY #1: Failure to Adequately Monitor a Postsurgical Patient DESCRIPTION OF THE EVENT This error-event involved inadequate monitoring of a patient who had undergone an elective surgical procedure. A certified nursing assistant made a proximal error when she failed repeatedly to report abnormal vital signs to a registered nurse assigned to the patient. The patient was receiving narcotics via a patient-controlled infusion device. The patient was obese and had a large neck. He also had a history of sleep apnea. This combination of factors may have combined to cause respiratory depression that resulted in abnormal vital signs. The nursing assistants reporting was inadequate, and consequently the registered nurse was unaware of the patients low blood pressure. The patients condition subsequently deteriorated to the point where he was seriously compromised and near death, and may have been permanently harmed as a result. DEMOGRAPHICS This error-event occurred in a community hospital setting. In this event the investigation revealed that three people made errors that constituted unsafe acts and resulted in harm to the patient. These included the nursing assistant, the registered nurse (who was prepared at the associate degree level), the registered nurse in the charge/staff nurse role, and a board-certified surgeon. The registered nurse and surgeon agreed to be interviewed, but the nursing assistant declined. Three additional people were indirectly involved and participated in the interview process. They were the oncoming registered nurse (prepared at the associate degree level of nursing), a registered (associate degree) respiratory therapist on duty, and the associate degree registered nurse house supervisor. The root cause analysis group included two of the people who engaged in unsafe acts, one other person who was directly involved, and six additional people with expertise in the routine practices and processes of the surgical unit and related areas. SETTING ELEMENTS The incident occurred during one 12-hour shift between Friday at 7:00 pm and Saturday at 7:30 am. All of the individuals directly involved in the event were working a regularly scheduled shift. The two employees who carried out the unsafe acts were working the night shift. The surgeon involved in the case had not worked the night before. BACKGROUND INFORMATION In the hospital setting, patients often receive pain medication through a pump that provides a specific dose on demand with a programmed maximum dose allotment. The patient-controlled analgesia (PCA) pump is programmed to deliver specific, small dosages of the medication only when the patient pushes a specified button. Therefore, if the patient is unable to push the button, he/she does not receive any more of the medication via the pump. NARRATIVE OF THE EVENT A young man, Mr. Steve Goldberg, was admitted to a surgical unit at 6:00 pm after an elective laparoscopic gastric bypass surgical procedure. Mr. Goldb
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