Scenario 17 - Discovery: Adverse Event Al Harman was a patient in Ross Community
ID: 127551 • Letter: S
Question
Scenario 17 - Discovery: Adverse Event Al Harman was a patient in Ross Community Hospital for a ruptured appendix which resulted in an appendectomy and 4 weeks of intensive antibiotic therapy. The severity of Mr. Harman's condition was exacerbated by his obesity and the length of time from his first symptom and when he sought care. During his stay he complained to the charge nurse that he was not receiving an adequate dose of antibiotics which was the cause of his infection and the length of his stay in the hospital. The charge nurse followed the hospitals risk management procedure, objectively documented the patient's complaint in the patient's record, and completed an incident report. 1. If a lawsuit is subsequently brought against the hospital, what role does the patient's record play in this situation? 2. Decide whether the incident report would or would not be subject to discovery by Mr. Harman's attorney. 3. Judge whether this incident represents a sentinel event as defined by The Joint Commission.Explanation / Answer
1) Medical Record keeping is an very important tool for the healthcare professionnals because of its role during any lawsuit or personal learning. In recent years, there have been many cases of negligence taken into court, but not always there is negligence in care. In such instances, the medical records have saved the reputation of the organisation as well as the career of an employee like doctor, nurses and paramedics. Hence, complete documentation of patient care in an appropriate manner is mandatory.
Documentation is a critical component in patient care delivery system, because it can enables the following factors;
- It helps in continuity of care
- It assist the team to understand and recall the care given to the patient
- It can be used as a tool to defend that the care is delivered
- It may prove that no negligence is being done to the patient in terms of care and quality
- It creates a database which can be used in due course of care or in future
- It forms a permanent data storage for the patient as well as healthcare personnels reference
And in this situation ,the patients record can be evaluated for any negligence or deviations in care. If the documentation is complete ,then it can taken as evidence to justify or defend that the care was delivered appropriately. It can help in preventing from facing consequences from the lawsuit.
2) Patient documentation is a main tool for verification of the past activities in the patients care by the care givers. And it is very obvious that the patients statement is taken into cosideration and an incident report is written on the basis of the patients verbatim. The only evidence which can suggest that the antibiotic administration was whether administered on time or not can be concluded from the patients documents.
Even the patients clinical records with certain investigations whic prove that there are other reasons for the cause of infection can also be taken into consideration. Hence, the incident report along with supporting documents will be considered for discovery by Mr.Harman's attorney. Because, this is also a form of standard protocols in hospital to tackle any untoward event and perform root cause analysis to understand the possible causes towards the event. The incident report includes complete data of patients demographic, clinical, assessment, medication details with supporting eveidence as well the root cause analysis. So,it is subject to discovery.
3) A Sentinel Event is defined by The Joint Commission (TJC) as any unanticipated event which results in serious permanent harm or death or temporary severe harm to a patient or patients in a healthcare settings,whic is unexpected in the natural course of the patients illness and which need immediate intervention to rectify the issue. Such events are called "sentinel" because thre is need for immediate investigation and response towrads the event. The top 10 examples of sentinel events analysed and reported by The Joint Commission are;
1. Unintended retention of a foreign object events
2. Fall-related events
3. Suicide events
4. Wrong patient, wrong site, wrong procedure events
5. Delay in treatment events
6. Criminal events (assault, rape, homicide)
7. Operation/post-operation complication events
8. Perinatal events
9. Medication error events
10. Fire-related events
And in this case, Mr.Harry has reported that improper antibiotic administration has caused increased hospitalization days. So,it indicates inadequate dose calculation or missing doses of antibiotics which comes under case of negligence and medication error of administration . So ,this might be considered as sentinel event.
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