Case Overview
The case with the 21-year old Yolanda Pinellas refers to an instance of malpractice that resulted in significant damage to the patient. During the intravenous (IV) therapy, infiltration occurred and, although the RN discontinued the infusion, Ms. Pinellas developed necrosis that required surgical intervention and ultimately led to the loss of finger function. The problem was likely connected to the activities of on-site nurses who were responsible for the administration and surveillance of the procedure. However, the hospital is liable for the incident as well since it had failed to arrange a proper nurse-to-patient ratio for several months before the described incident took place. Since Ms. Pinellas claims that she can no longer perform as a music conductor, the hospital will likely have to pay substantial monetary compensation to her for the caused harm.
Violated Standards of Care
Standards of care are authoritative statements providing a thorough explanation of competencies and skills that every practitioner should possess in order to render high-quality care. Compliance with standards of care is an essential duty of each healthcare specialist. The cases of malpractice, such as the one described above, are usually related to the violation of such standards included in the American Nurses Association (ANA) Scope and Standards of Professional Nursing Practice as Implementation and Quality of Practice.
Standard 5: Implementation basically refers to adequate administration of intervention and treatment plans (ANA, 2015). Besides that, it indicates that nurses should collaborate with patients and colleagues in order to ensure the utmost effectiveness, efficiency, safety, and quality of care (ANA, 2015). Overall, compliance with this standard means that a healthcare practitioner has all the necessary technical skills to perform their duties and, moreover, is accountable for patient needs and interests. In the case of Ms. Pinellas, neither of those core requirements were met since nurses failed to respond to the problem appropriately and undertake measures to prevent complications. In addition, neither did they communicate with the patient nor explained the nature of the occurred issue.
Standard 14: Quality of Practice is one of the core medical standards and is consonant with many ethical and professional principles that healthcare practitioners of different specialties and in various roles are obliged to follow. In accordance with this standard, a nurse must ensure that “nursing practice is safe, effective, efficient, equitable, timely, and patient-centered” (ANA, 2015, p. 79). It means that efficiency and safety should be strived for on all occasions and in regards to each patient. It also means that nurses should aim to promote a higher quality of care at the organizational level and advocate for the protection of patient interests.
As it is clear from the introduced case, Standard 14 was met neither at the individual nor at the hospital levels. Even though it is not clear whether IV infiltration took place due to patient-specific or nurse-specific factors, the fact that IV was dislodged when RN approached the patient can indicate that an IV catheter was not inserted correctly. In addition, Keleekai et al. (2016) state that infiltration occurs in 23.9% of situations associated with premature IV catheter removal. However, while the nurse involved in the administration of medication for Ms. Pinellas could be devoid of necessary skills to insert/remove IV catheter and monitor the IV therapy, the hospital failed to create a supportive workplace environment with opportunities for technical and professional assistance and psychologically favorable conditions with a minimal number of job-related stressors.
Analysis of Contributing Factors and Responsibilities
Clearly, the nurse involved in the case of Ms. Pinellas contributed to the aggravation of her health condition. Nevertheless, her role is merely partial and, it is valid to say, that the hospital administration may be the one to blame. As noted by Raveesh, Nayak, and Kumbar (2016), hospitals can be directly or vicariously liable for medical negligence and malpractice. Whereas direct liability implies “the deficiency of the hospital itself in providing safe and suitable environment for treatment as promised,” vicarious liability refers to “liability of an employer for the negligent act of its employees” (Raveesh, Nayak, & Kumbar, 2016, p. S16). It means that hospitals are responsible for employing competent workers, implementation of adequate staff monitoring mechanisms, and making sure that the organization has enough resources to ensure patient safety. It is possible to say that all three of these criteria are not met in the case of Ms. Pinellas, yet the last one – hospital deficiency to promote safety culture – seems to be of greater importance, indicating that the hospital may bear direct liability in the malpractice action.
The links between nurse staffing and patient safety and omissions are well-established in multiple studies. As Griffiths et al. (2018) mention in their systematic review, improper nurse staffing is positively correlated with poor patient outcomes and mortality, in particular. When nurses have excessive workloads and insufficient time to perform their duties, they tend to omit and delay certain care activities, including the most essential ones, such as measurement of patients’ vital signs, and often fail to detect the symptoms of aggravation early (Griffiths et al., 2018). Moreover, low staffing levels and consequent unmanageable workloads increase practitioners’ exposure to stress, resulting in an elevated risk of burnout, poor health, and reduced morale (Hall et al., 2018). It is valid to say that even the most competent and experienced specialists are bound to make mistakes in overly stressful and demanding circumstances. Since the hospital in the analyzed case failed to do so, the accountability for the damages to the patient’s health falls mainly on it. Overall, though hiring more nurses seems to put too much financial pressure on the organization at first, it may save much more money for hospitals because the costs of patient neglect, malpractice, and poor quality of care are usually extremely high.
Incident Response and Risk Management
When responding to Ms. Pinellas’ action, the hospital must admit its mistakes and apologize. According to Raveesh, Nayak, and Kumbar (2016), such an approach can substantially reduce the cost of malpractice in the end. In addition, it may be recommended to engage in an open and trustful conversation with the patient, trying to reach agreement on compensation and avoid the lawsuit. Consequently, it would be appropriate to focus on the improvement of nurse-patient communication at the hospital level as well because better relationships between practitioners and patients, and provision of information regarding all possible treatment risks to the latter can save the hospital from malpractice claims.
Another way to manage the risk and prevent similar incidents is through adequate staffing. The hospital should strive to offer the right work-life balance for its practitioners and arrange optimal nurse-to-patient ratios and develop its internal structures and processes in a way that supports patient safety and better care quality. In the future, the hospital must ensure strict compliance with all professional standards. This step requires a change in the attitude at both the administrational and individual levels and involves the establishment and promotion of the safety and quality cultures.
References
American Nurses Association. (2015). Scope and standards of nursing (3rd ed.). Web.
Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., … Missed Care Study Group (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474-1487.
Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PloS One, 11(7), e0159015.
Keleekai, N. L., Schuster, C. A., Murray, C. L., King, M. A., Stahl, B. R., Labrozzi, L. J., … Glover, K. R. (2016). Improving nurses’ peripheral intravenous catheter insertion knowledge, confidence, and skills using a simulation-based blended learning program: A randomized trial. Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 11(6), 376-384.
Raveesh, B. N., Nayak, R. B., & Kumbar, S. F. (2016). Preventing medico-legal issues in clinical practice. Annals of Indian Academy of Neurology, 19(Suppl 1), S15-S20.