Case Study: S/O EMT Perez

The plaintiff in Ard v. East Jefferson General Hospital, stated on 20 May, she had rang the nurses station to inform the nursing staff that her husband was experiencing symptoms of nausea, pain, and shortness of breathe. After ringing the call button for several times her spouse received his medication. Mrs. Ard noticed that her husband continued to have difficulty breathing and ringing from side to side, the patient spouse rang the nursing station for approximately an hour and twenty-five minutes until the defendant (Ms. Florscheim) enter the room and initiated a code blue, which Mr. Ard didn’t recover. The expert witness testified that the defendant failed to provide the standard of care concerning the decease and should have read the physician’s progress notes stating patient is high risk upon assessment and observation. The defendant testified she checked on the patient but no documentation was noted. The defendant expert witness disagrees with breech of duty, which upon cross-examination the expert witness agrees with the breech of duty. The district judge, upon judgment, the defendant failed to provide the standard of care (Pozgar, 2012, p. 215-216) and award the plaintiff for damages from $50,000 to $150,000 (Pozgar, 2012, p. 242).

This critical incident took place during my first six-week placement on the ward (Eleanor east). My rationale for this critical incident is because of the impact it had on me. I did not know that the side effects of hip replacement surgery could result in DVT (deep vein thrombosis), which could be very critical physically and mentally.

As noted, on February 29, 2016, the patient was nonetheless admitted to the UCR hospitalist. This was a senior member of the UCR hospitalist team who knew or should have known all of the policies and procedures for admission, and should never have admitted the patient as an attending to the hospital. In so doing, he was directly and deliberately interfering with the doctor patient relationship.

We know that he had sustained an at home fall. We learn that he has a history of pain and a prescription for oxycodone for back pain. We know that his vital signs on admission appear stable; he was not showing any signs of respiratory distress. As we look at the staff that was listed that day we do get the sense the hospital may have been short staffed. Staffing report shows there was one MD, one RN and one LPN managing at least 4 patients including- one patient was a child. Evidence based research has proven that the nurse to patient ratio is directly related to the patient outcomes (Stanton, 2004). It is important that we consider the staffing level that this rural ED as we know short staffing can be blamed for not being able to take the full amount of time needed to do a proper health history. A detailed health history is an imperative part of the care process; it is used by the staff to accurately assess any acute changes that may take place in the patient throughout their stay.

There was additional backup staff present (including a respiratory therapist) that could have been called upon for help, yet they never were. The charge nurse or nurse supervisor could have stepped in at this point to provide additional help. A lack of present nursing staff and support can lead to unfavorable patient outcomes, as is the case with Mr. B. Additionally, the staff on duty could have lacked training regarding protocols or their training could have been out of date.

Meanwhile, elsewhere in Habersham County, Tom was feeling slightly nervous as he exited the staff lounge and entered the hustle and bustle of County Hospital’s ER to begin his first shift as an RN. The first few hours of his shift passed slowly as Tom mostly checked vital signs and listened to patients complain about various aches, pains, coughs, and sniffles. He realized that the attending physician, Dr. Greene, who was rather “old school” in general about how he interacted with nursing staff, wanted to start him out slowly. Tom knew, though, that the paramedics could bring in a trauma patient at any time.

He was brought in by his friend Gavriel Martinez. At 2338 hours Orange County Sheriff's Deputies Kenneth Jorgensen (Badge# 8180) and Deputy Michael Fairley (Badge# 6210) arrived and interviewed the GSW patient, both deputies were already on site for an unrelated event. Security Manager Richard King was informed by text of the incident at 2340 hours as well as Nursing Supervisor Debra Reilly. At 2350 hours OCSO Deputy Kristine Helms (Badge# 5021) arrived and requested to speak to the patient’s friends who was waiting in the E.D. lobby. At 0010 hours Deputy Michael Fairley contacted SO Alonso and advised that it was OK to open the Emergency Department. The lockdown was lifted and Security Manager and Nurse Supervisor were informed of the incident. The patient, Lopez was airlifted to Orlando Regional Medical Center (ORMC) at 0030 hours at which time OCOS Deputy Kristine Helms informed me that the Gang Unit task force has been called for further investigation. All cleared, OCOSO report number 16-43967. Nothing further at this

On 3/13/16 SO EMT Perez was notified that an engine had come on campus.  SO EMT Cunningham responded along with SO EMT Perez and caught up with the engine by lakeside commons. The driver of the engine stated that he was responding for a lift assist to 3144/3146 apt 220 but that he wasn’t sure which one he was going too. SO EMT Cunningham and SO EMT Perez decided to respond to FR-220 first being that they were the engine came from gate 2 and they were closest to that building. SO EMT Perez and SO EMT Cunningham knocked and announce their presence at FR-220’s door and were both verbally invited in. The resident a Mrs. Helen Neff stated that she could not get out of her chair because it was stuck and needed help getting out of it. SO EMT Perez

On 10/21/2015 SO EMT Perez was dispatched to HS-318 regaurding a general assistance call. SO EMT Perez knocked and announced his presnece at the door and was verbally greeted in by the resident, a Mrs. Netha Hopson. Mrs. Netha Hopson stated that she needed help retrieving her purse because her motorized chair was caught on it and she could not get it untangled on her own. SO EMT Perez managed to untangle the purse and retrieve it for Mrs. Netha Hopson. After insuring that Mrs. Netha Hopson needed nothing else SO EMT Perez cleared the scene without further incident.

On 10/4/2015 S/O EMT Perez was dispatched to MG-T15. S/O EMT Perez knocked and announced his presence at the door and was greeted by the resident, a Mrs. Maxine Montgomery. Mrs. Maxine Montgomery stated that she needed some help re ajusting her sling and was unable to do it herself. S/O EMT Perez adjusted her sling and asked if Mrs. Maxine Montgomery needed any asistance with anything else and or needed any aditional care. Mrs Maxine Montgomery stated that she was fine and needed no adititional care and escorted S/O EMT Perez out. S/O EMT Perez cleared the scene without further incident.

S/L Walker was dispatching for evening shift at 08/29/15. S/L Walker receive a call for a welfare check at KC-219. The daughter, Karen, usually talk to her mother at around 2100 hr. But tonight could not reach her. S/L Walker took down the information and send an officer up to the apartment. S/L Walker called the apartment while the Officer was en route. There was no answer by phone. S/L Walker notified the Officer. S/O EMT Funes was the reporting officer. When S/O EMT Funes arrived on the scene, there was no answer by knock. S/O EMT Funes entered via her master key because the door was lock and search the apartment. There was no one home and S/O EMT Funes left a white tag #28798. S/O EMT Funes cleared. S/L Walker called the daughter twice

It's Rose Ann. I just want to let you know that Mr. Bogue, James in room 564, MRN 291222300018 fell yesterday around 4pm. He was Amanda's patient and she completed the voice. I notified our risk management Jodi Palmer about the incident. Apparently the patient was instructed by Amanda not to get up because he was hypotensive, but he didn't listen and grabbed the walker and fell forward. We ended up calling RRT because he was hypotensive and developed a big hematoma on his right groin surgical post angiogram from previous day. The patient was transferred in ICU12. We were short staff from 7a-7p, I called everyone with no luck. Our nurses and PCA were overwhelmed, because we kept on getting multiple admissions, including 2 cath lab patients

Bryheem Brown: Got a call from dispatch to take a patient from 610 ER to 3W19. This call was on the board for 1 hour before it was sent out. The ER must of took the patient up for us. When Bryheem went down there to take 610 upstairs, there was a new patient assigned to the room. Bryheem must of not checked the wrist band because he took the patient upstairs. That patient he took upstair wasn't the patient dispatched to him. The ER did report it.

The objective of this reflection is to explore and reflect upon a situation from a clinical placement on an orthopedic unit. The incident showed that I did not provide safe, timely and competent care for my patient when the oxygen saturation was low. Furthermore, this reflection will include a description of the incident, and I will conclude with explaining what I have learned from the experience and how it will change my future actions.

During the home health observation day, there were several opportunities to observe a variety of patients with varying levels of functioning ability, different illnesses, and different needs and levels of interaction with the nurse. The first patient seen was a seventy-three year old Caucasian female with an ulcer on her right heel. Several weeks prior, she had scratched her left leg and she also had several small wounds on her left leg. The orders were to clean and redress the ulcer. She has a history of end stage renal disease, pneumonia, weakness, diabetes, dialysis, and right hip fracture. Upon entering the home, the patient was found to be sitting in a wheel chair in the living room watching television with her husband close by her side. She greeted the nurse with a smile and began to update her on her current condition. Her heel was “hurting” and she rated her pain an 8 on a scale of 1 to 10. She also had some “swelling” that she could not “get to go away; because, she could not get up and walk. They need to fix my foot so that I can get up and get around.” She told the nurse that she had been to see the doctor “yesterday” and the doctor had given her a written order that she wanted her to see. The order was written for an evaluation for a soft pressure shoe fitting. The nurse read the order to