Introduction
The standard of care refers to the degree of support, focus, expertise, and conviction a nurse demonstrates, as evaluated by expert testimony. They are continually evolving and are informed by evidence-based practices. These guidelines govern the practice of nurses at all levels of practice and in all nursing specialties, providing a baseline for evaluating the quality of care. They are created in consideration of the laws, rules, and regulations that govern nursing practice at the federal and state levels.
Irrespective of clinical practice, national care guidelines apply to nursing practice. Registered nurses with specialized expertise are known as advanced practice nurses (APNs), and they help provide patient-centered, affordable, and convenient care. The nurse practitioner’s function aligns with the consensus model of the APRN and involves providing healthcare to a range of people in various healthcare settings. Given Yolanda’s case study, this essay provides a brief explanation of the situation while evaluating the APN’s function, highlighting the legal ramifications, such as neglect and probable malpractice, and considering risk mitigation techniques.
Case Summary
Yolanda Pinellas, a 21-year-old girl who was being investigated for the patient situation, was taken to the hospital for chemotherapy. An infusion pump was used to give the antibiotic mitomycin intravenously. The nurse noticed that the IV was loose during the night shift. She immediately stopped the infusion, alerted the doctor, and attended the infusion site.
The patient said that although unaware of further measures, the nurse touched the button to stop the bump from beeping. The nurse recorded IV infiltration in the patient’s medical file. After two weeks, the patient’s hand required many procedures due to necrosis. As a result, the patient was unable to pursue her music career because it affected all her fingers.
A nurse failing to follow the prescribed standard of care is a violation and may result in legal repercussions, including negligence and a malpractice claim. Physicians threaten a malpractice lawsuit when they offer poor treatment, which causes the patient harm or injuries. In Yolanda Pinellas’ case, neither the practitioner nor the provider confirmed nor distinguished between the diagnoses of extravasation and infiltration.
Extravasation refers to the unintentional flow of a vesicant into nearby tissues from a vein (Kreidieh, 2016). Infiltration, by contrast, is the leakage of a non-vesicant into adjacent tissues. It would have been necessary to intervene correctly after stopping the chemotherapeutic drug. Several situations in this scenario might be viewed as an infraction of the nursing standards of practice and the standards of care as required.
Violation of Standards of Care
Inadequate Communication
The nurse’s communication was ineffective, resulting in the infringement of nursing care standards. To prevent injury and guarantee that the right course of treatment or interventions is recommended, the practitioner must be informed of changes in a patient’s health (Ashton, 2019). By combining and evaluating the health history data with any diagnostic or evaluation information provided, the practitioner would have swiftly validated the diagnosis at this point (Tiwary et al., 2019). Vesicants frequently induce significant tissue damage that can linger for many hours.
Further, chemotherapeutic agents must be administered while the infusion is being watched. As a protocol in the extravasation scenario, it is advisable to stop the drip while keeping the cannula in place, swab the area with the chemotherapeutic drug, and then remove the cannula or port needle (Kreidieh, 2016). Furthermore, the caregiver would have advised elevating the affected limb, photographing it to monitor healing, applying a cold compress, and possibly using a saltwater dispersion to neutralize the vesicant and prevent tissue damage (AANP, 2019). In this case, the lack of communication hindered the rapid treatment and necessitated a change to the patient’s care plan.
Poor Treatment and Documentation
Second, this scenario failed to illustrate an adequate care approach by not treating the extravasated location promptly. In this scenario, the care and discussion with the practitioner were not recorded. According to AANP (2019), one of the most effective methods to protect against malpractice or negligence lawsuits is by documenting care.
In this case study, the specifics of the treatments and the development of the specified IV site were neglected. A communication mechanism for a collaborative practice, which is often overlooked in this case, is thorough documentation. The case study did not record linked interventions, treatments, or progress.
Inadequate Follow-Up Care
Third, there were insufficient follow-ups and assessments of the patient’s condition in Yolanda Pinellas. The scenario does not mention the practitioner monitoring the patient’s limb and reporting progress. The attendant failed to monitor the patient’s health and make the necessary referrals for treatment.
The American Association of Nurse Practitioners’ Standards of Practice include evaluating the treatment plan’s efficacy and ensuring appropriate documentation (AANP, 2019). These guidelines call for reevaluating and adjusting the future treatment plan to meet the patient’s and their family’s aspirations for the best possible health outcomes. Various approaches to the extravasation include localizing and neutralizing the chemotherapeutic agent, increasing the frequency of examinations, careful photo documentation, surgical review, or scheduling follow-up meetings for the patient. This situation demonstrates a violation of the norms of practice, which would likely result in a legal inquiry and potential disciplinary action.
Risk Management Steps
Before the Incident
Risk offices aim to enhance the standard of medical treatment by identifying and mitigating risks and harms to patients, employees, and visitors. The majority of extravasations may be stopped using research-based and standardized administrative techniques. Before this unfortunate occurrence, a risk management team may have taken several actions (AANP, 2019). First, ensure that relevant local institution rules are available, with a focus on administering intravenous infusions appropriately and avoiding unintentional extravasation. Second, by putting more emphasis on proactive care than reactive treatment, training, and education for practitioners and nurses. Third, extravasation kits, including disposable syringes, cold and hot packs, and other used items, should be placed on treatment units.
After the Incident
The health center must conduct a root-cause investigation following an adverse incident involving a patient to establish causality. A root-cause analysis seeks to identify a suitable remedial strategy to resolve this incident and prevent similar incidents. With this strategy, the organization diverts attention away from local policies that may have led to the disaster and toward global ones. Second, it is essential to bridge communication gaps across different professions. The level of service, patient experience, resource allocation, and healthcare costs are all impacted by inadequate communication across healthcare teams. Communication breakdowns might cause care or treatment to be delayed.
Conclusion
In conclusion, this case study examined numerous transgressions of the nurse practitioner’s standard of care. Violating the code of conduct increases the likelihood of malpractice, neglect, and adverse patient outcomes. The nurse and nurse practitioner’s interdisciplinary communication combined prevented Yolanda Pinellas from receiving the best care possible. By applying organizational concepts, tools, and tactics, suitable risk management techniques can be implemented both before and after such occurrences to mitigate future risks associated with hazardous treatment. The nurse practitioner’s responsibility is to understand state laws and federal practice standards, which impact their immediate scope of expertise, and specify the best ways to administer care.
References
American Association of Nurse Practitioners (AANP). (2019). Standards of Practice for Nurse Practitioners.
Ashton, K. C. (2019). Standards of Care and Standards of Practice. Journal of Legal Nurse Consulting, 30(4), 10–13.
Kreidieh, F. Y. (2016). Overview, prevention and management of chemotherapy extravasation. World Journal of Clinical Oncology, 7(1), 87.
Tiwary, A., Rimal, A., Paudyal, B., Sigdel, K. R., & Basnyat, B. (2019b). Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports. Welcome Open Research, 4, 7.