A medical practice requires effective communication both between patients and healthcare workers and within the team of healthcare workers. However, medical errors often occur because of miscommunication. In the clinical case analyzed in this paper, a medical error happened due to a lack of communication. In this case, the nursing assistant reported to the registered nurse that the patient scheduled for discharge developed a urinary tract infection. However, the registered nurse decided not to report this issue to the physician to avoid additional hospital work. By failing to report the patient’s problem, the registered nurse violated the two core principles of medical ethics: beneficence and non-maleficence. Beneficence requires a healthcare worker to always act in the patient’s best interests, and non-maleficence implies not causing any harm to the patient (Varkey, 2020). Creating checklists for nurses and patients for effective communication of patient complaints and concerns about all organ-systems can provide an objective view of a patient’s state and prevent a repeat of this situation.
Hospital-acquired infection is a widespread problem across many medical institutions. As healthcare workers know, a bladder infection can be treated with an empiric antibiotic regimen. Although there are some financial costs because of additional laboratory tests and treatment, there are no legislative consequences for hospitals for hospital-acquired infections (Friedman, 2016). There were two critical errors of judgment by the nurse. First, the registered nurse assumed that there are economic responsibilities for the hospital. Second, she was concerned about an unfavorable view of the hospital by the patient. The first judgment is wrong because the hospital does not have financial responsibilities for healthcare-associated infections. Furthermore, antibiotic-resistance is a global problem. Although there will be additional expenses for a more extended hospital stay, laboratory tests, and medications, health insurance should cover such costs. The second judgment is wrong as before giving consent for a surgical procedure, patients are notified about all complications during and after the surgery. Thus, the negative view of a hospital is unlikely. Considering this scenario, the hospital may have severe legal and financial consequences because the patient may develop a complication from the UTI and may consider suing the hospital for delaying treatment.
To prevent similar situations, the hospital needs to introduce more effective reporting and communication strategies. According to Wang, Wan, Lin, Zhou, and Shang (2018), such methods as checklists and templates for patient assessment improve communication between nurses and physicians and prevent misunderstanding. One of the possible strategies to avoid such problems is introducing checklists for patients and healthcare workers to address all patient complaints and concerns before discharging. The first step to implementing this communication strategy is for physicians to prepare checklists about all organ and systems possible problems and complaints. Second, physicians need to discuss the importance of honest completion of a checklist for every patient. The difference in hierarchical position and lack of shared vision are the main obstacles for effective communication between nurses and physicians (Nieuwboer et al., 2018). Therefore, physicians should conduct the discussion respectfully. Physicians and healthcare managers need to explain to nurses the consequences of every specific action or inaction. Finally, physicians should be prepared to compare three different checklists for each patient, which may be time-consuming but an effective strategy.
Overall, choosing a practical multilayered approach to intrahospital communications is essential to prevent medical errors. In this case, the nurse withheld from the physician a vital piece of information about the patient’s health which may cause negative consequences for the hospital. Therefore, explaining legislative and financial consequences of reporting and non-reporting of such issues to the hospital staff can prevent damage to a patient’s health. The registered nurse had judgment errors about this situation. It is essential to provide appropriate training to hospital personnel about the proper evaluation of patient health during a hospital stay and upon discharge. Introducing checklists to evaluate patient health at multiple levels may help avoid situations that may cause damage to patient’s health.
References
Friedman, C. (2016). The costs of healthcare-associated infection. In C. Friedman (Ed.), Basic Concepts of Infection Control (3rd ed., pp. 1–9). International Federation of Infection Control.
Nieuwboer, M. S., Perry, M., van der Sande, R., Maassen, I. T. H. M., Olde Rikkert, M. G. M., & van der Marck, M. A. (2018). Identification of influencing factors and strategies to improve communication between general practitioners and community nurses: A qualitative focus group study. Family Practice, 35(5), 619–625. Web.
Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 17–28. Web.
Wang, Y. Y., Wan, Q. Q., Lin, F., Zhou, W. J., & Shang, S. M. (2018). Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review. International Journal of Nursing Sciences, 5(1), 81–88. Web.