Malpractice

 Multiple legal malpractice issues and violations of medical standards of care arise in the course of providing care to patients. However, nurses are trained to be patients’ advocates in every clinical scenario even in cases involving malpractice. Nurse practitioners (NPs) are prepared to provide reasonable and competent care to patients in primary, specialty, and medical care settings. Providing competent care involves the major role of NPs in ensuring patients’ safety in the course of care. The case provided involving Yolanda Pinellas is an illustration of how medical practitioners violated standards of care for a cancer patient which resulted in malpractice. The nurses failed to protect the safety of the patient by monitoring the chemotherapy pump which is an illustration of substandard care that later caused harm to the patient.

The NPs are mandated to maintain standards of care stipulated in their scope of practice. In the provided case, the major violated standard of care is related to the element of negligence. Negligence is shown by the way the nurses handled the patient in different scenarios. The nurse who stopped the pump was negligent in fact that she did not take the initiative to explain to the patient what was happening. Patients have the right to be abreast of every procedure involving their care. The nurse on duty who was assigned to the patient did not take the initiative of acting promptly in case the pump alarms. This is a clear illustration that the nurse neglected the duty of monitoring and assessing the patient during treatment. If the nurse had accurate monitoring of the pump further harm on the patient could have been prevented. The fact that the nurse documented in the medical records that there was infiltration of the IV line when the patient was receiving mitomycin but did not push for further action is a clear sign of negligence. Documented events should have clearly outlined interventions. Relevant risk management steps could have been initiated after the event to prevent further harm to the patient.

All the medical practitioners related to Yolanda’s case violated standards of care in the course of providing Yolanda with care. The evening nurse violated the standard of care by waiting until the pump started to beep before getting to the room. She should have been available to detect defaults in time. The physician also violated the standards of care by the fact that he/she was notified in time but nowhere in the case illustrates the action taken by the physician in relation to the notification. The nurse who notified the physician equally failed to act as a competent patient advocate. Nurses should advocate for patients by pushing for actions to ensure patients achieve excellence care. The nurse who provided care to the infusion site equally violated the standards of care by the fact that she did not bother to identify herself and explain to the patient her treatment process. The risk manager violated the standards of care as she had noted before that the hospital was understaffed. However, the manager did not take the necessary steps to ensure that more nurses are recruited to prevent current nurses from working double shifts. More cases of negligence and violation of standards of care occur in scenarios where nurses are understaffed and overworked. The risk manager did not bother to ensure that nurses have a standard flexible timetable to prevent cases of float nurses running some shifts which endangers patients’ safety.

There are various risk management steps that could be initiated in the case of Yolanda before the event to prevent the occurrence of adverse events. The initial step involves establishing the context of the risk. The RNs could have kept in mind that infusion of chemotherapy drugs is one of the contextually high-priority areas in nursing practice where risk management should be conducted. The RNs should have ensured that the pump is serviced and maintained before connecting the patient. The next step involves establishing the risk. The RNs could have assessed the possible risks related to infusing a patient with mitomycin. The most possible risk is dislodgment of the IV line and infiltration of the drug to the tissues. The nurses could then have analyzed the risks involved with the infusion. This could have improved their understanding of the identified risks and established possible existing control measures. Such measures could have included accurate monitoring of alarms or beeps from the pump.

The next step involves the evaluation of the risks. The RNs in the case could have prioritized the order of the possible risks and decided on the risks that require immediate medication and attention in case of occurrence. Evaluation of risks could have prompted actions to alleviate the effects of mitomycin infiltrating in the tissues. Evaluating the risk could have also promoted patients’ safety as nurses could be keener to reduce the severity of the infiltration. The final step involves mitigating the risk. This step concurs with the NP's role in treating illness. Here, the RNs could have proposed in the case of how plagiarism checker works actions related to potential risks and the timeframe for implementation. Such a plan could have pushed the RNs who notified the doctor to push for action on the patient.

There are multiple risk management steps that could have equally been taken after the event to prevent further adverse events on the patient. The first step involves assessing the extent of the event. The RNs together with the other medical practitioners could have assessed to magnitude of infiltration that Yolanda experienced. This could have prevented delay in the provision of promotive care which in the case was initiated two weeks later after the patient had developed necrosis. The next step could have involved assessing the treatment options. This step enables the NPs to select the best course of action from a set of solutions. The best solution that can cause no further harm to the patient could be initiated. A critical analysis of the selection of the plan of action could have been conducted before the implementation. Another step involves close monitoring and follow-up after the event to prevent complications. This step is essential as intervention could have been initiated early enough before the patients’ hand necrotized. The final step would involve the implementation of the best-chosen action in the most competent way. Being competent when implementing the plan prevents further harm or complications to the patient.