N3375 Module 4: Malpractice Assignment
Submit by 2359 (CT) Saturday
Name: Date:
Overview: Malpractice
Each year, nurses make themselves vulnerable for potential malpractice claims because they are not well-informed about malpractice elements. You will read two fictitious scenarios and identify pertinent facts that pose risks for malpractice claims.
Refer to your course readings and lectures as you complete the assignment.
Objective:
• Apply the four elements of a malpractice claim to specific incidents.
Rubric
Please see the rubric in Canvas for how your assignment will be evaluated.
Part 1: Potential Malpractice Claim #1
A. Read this scenario. Decide if the situation presents potential elements of malpractice.
A 65-year-old female patient was taken to the emergency department (ED) after suffering a fall at home. Her husband had been away from the house several hours and when he returned home, he found her on the floor. The patient was confused, and no one was able to ascertain how long she had been lying on the floor.
She was taken to the nearest emergency department with complaints of weakness, confusion and right lower leg and foot pain. Her past medical history included Parkinson’s disease, mild dementia, hypothyroidism and anxiety.
The radiology results revealed an open displaced fracture of the right tibia and fibula. An orthopedic surgeon requested the patient be prepped for surgery. However, there was over a four hour delay getting the patient to surgery for various reasons.
The patient underwent surgery which lasted approximately three hours. In the intraoperative nursing (pre-operative and post-operative) assessment, documentation regarding skin integrity was incomplete as well as documentation of the position aides.
The patient was taken to the surgical floor with orders to be placed on the post-surgery protocol. The protocol included comprehensive orders for vital signs, pain control, nutrition, hydration, mobilization and skin integrity prevention measures. The admitting nurse assessed the patient’s skin and gave her a risk score of 14 according to the Braden Scale® (the lower the number, the higher the risk to develop pressure ulcer). The hospital’s “Alteration in Skin Integrity” protocol required an air mattress for any patient with a score of less than 18.
Although the admitting nurse ordered medical air mattress overlay for the patient, the hospital did not have any available. A request for a mattress was placed with an outside vendor, but since it was a holiday weekend the delivery of the mattress would take at least eight hours. The following day (post-operative day one), the day shift nurse assessed the patient and documented a skin assessment score of 20.
Skin assessments and repositioning documentation were missing on several shifts, despite hospital policy. Skin checks are required once a shift and skin integrity protocols require repositioning a patient every two hours.
On post-operative day three, the night shift nurse reported the presence of a purple localized area of discolored intact skin on the patient’s sacrum. However, it wasn’t until the night nurse returned that the patient was finally placed on an air mattress. On post-operative day five, the patient was discharged to a local skilled nursing facility. The patient’s admitting diagnosis to the skilled facility was status-post operative leg surgery, Parkinson’s disease, mild dementia, hypothyroidism, anxiety, anemia and Stage IV decubitus ulcer.
Over the next nine months the patient suffered from infections, debridement and anemia all related to the sacral ulcer. At one point the size of the ulcer was 8.5 cm in length, 7cm in width and 4 cm in diameter. To prevent further infections the patient underwent a sigmoid loop colostomy, a sacral osteotomy and a second bilateral gluteal flap repair for the non-healing ulcer. A urinary catheter was used to prevent further skin breakdown and since the patient struggled with malnutrition due to infection, a gastrostomy tube was inserted during one of her hospitalizations.
The patient died 10 months after her fall.
B. List the 4 elements of a malpractice claim in the left hand column.
C. For each of the 4 elements, state which, if any, of the facts in the scenario support that specific element. You may leave the ‘Pertinent Facts’ column blank for an element if there are no facts to support it.
Elements of Malpractice Claim Pertinent Facts
D. CONCLUSION: Was this malpractice? YES/NO
Part 2: Potential Malpractice Claim #2
A. Read this scenario. Decide if the situation presents potential elements of malpractice.
The patient / plaintiff was a 40-year-old female undergoing Mitomycin chemotherapy for anal cancer following surgery and radiation. The patient alleged that the defendant nurse incorrectly placed the intravenous line (IV) resulting in infiltration with extravasation of the Mitomycin into the tissues of her right hand. The patient further alleged an inadequate number of nurses resulted in improper supervision of her chemotherapy treatment by the defendant nurse.
The defendant nurse inserted a peripheral IV into a vein on the dorsum of the patient’s right hand for the administration of Mitomycin. The IV was inserted without difficulty. When she later checked the patient’s IV, she noted that the needle had dislodged from the patient’s vein. There was no evidence that the Mitomycin had extravasated into the patient’s tissues.
The defendant nurse immediately stopped the IV, notified the physician and provided care to the patient’s hand. The documentation indicates no immediate adverse effects.
Three months following the event, the patient developed necrosis of the dorsum of the right hand. She required multiple surgical procedures, skin grafting and reconstruction with permanent loss of function and significant deformity including lack of movement of the fourth and fifth fingers. The patient also alleged pain and suffering and permanent disabilities interfering with recreational activities and daily living.
A. List the 4 elements of a malpractice claim in the left hand column.
B. For each of the 4 elements, state which, if any, of the facts in the scenario support that specific element. You may leave the ‘Pertinent Facts’ column blank for an element if there are no facts to support it.
Elements of Malpractice Claim Pertinent Facts
B. CONCLUSION: Was this malpractice? YES/NO
Submit this Assignment Document into Canvas for grading.
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