Nursing Assessment Liability, comment

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Although a good nursing assessment is an important part of patient care, I don’t believe that there is a definite preventative factor in whether or not a person can or will die from an assessment that something is missed. Assessments can be “hit or miss”. I believe that documentation is extremely important when doing an assessment. One moment, things could be completely normal, and the next, the patient’s life could be in jeopardy. For example, a fatal MI. One patient could have a perfectly normal heart rate and rhythm and then go into a v-tach or v-fib. On the other hand, if the patient is very ill, a careful and thorough assessment should be performed by the RN several times per shift to monitor deterioration in condition. I believe it comes down to documentation of assessment to really be accurate on a patient’s true condition at the time of the assessment.

Original Post:
November 3, 2006
More and more liability is being place on nursing assessments when cases are brought to court and unfortunately, more and more often the nurse is being blamed for the medical mishap.

It is incredible to think the surgical scrub nurses would be liable in the court of law when a physician removed the wrong limb. Today, it is the responsibility of all health care entities to take an active role in assessment of patients prior to any procedure. Did I say health care entities or did I mean to say nurses. As nurses, it is vital that we take our assessment skills seriously and use then at every opportunity in no matter where we work whether in a surgical suite or primary care office.

This brings up the topic of nurses knowing what to assess when caring for their patients. For example when a nurse is caring for the Emphysema patient and the physician orders O2 at 10L via nasal cannula. Using your nursing assessment skills, one might question the appropriateness of such a high flow via the nasal cannula. On the other hand, the patient who has CHF and is receiving 80 mg. of lasix every 6 hours IV for diuresis but potassium replacement has not been ordered nor are post lasix labs ordered and through your nursing assessment, the patient is complaining of feeling strange. Will your nursing assessment skills bring these issues to the attention of the physician and prevent a potential fall, which could end up causing the patient to fracture their hip thus causing a thrombosis, which could potentially cause death in any patient.

Another good example would be the potential for medication errors committed by either nurses or physicians. Many forensic medical cases are related to some sort of health care entity error. Having good assessment skills along with good nursing knowledge has prevented many deaths while caring for patients. But then again having good nursing assessment skills can reassure a nurse that she/he has done the very best in caring for the patient.

This reminds me of a situation that happened back in the mid-nineties when I floated to a dialysis in-patient unit. I was assigned to care for four patients. All of the patients on this unit were on cardiac monitors. One of my patients was a young woman in her early fifties. She had just been diagnosed with renal failure and had received her first dialysis treatment via IV cannula that day. This patient was also an employee at this very hospital. Early in the evening, the patient complained of anxiety and it was noted that she had valium ordered for anxiety, so after a thorough assessment of the situation the patient was given the valium. Later that evening around 10 pm, the patient complained that she was still feeling anxious and was not able to sleep. According to the physician order, the valium could be repeated if needed. After again a thorough nursing assessment and consultation with the charge nurse, the second valium was given to the patient. As the early morning was approaching and the lab technicians were doing their morning lab draws and the nurses were at the nursing station closing their patients charts, one of the cardiac monitors went off indicating abnormal heart rhythm- it was my patient. We called the code blue and ran to the patient’s room with the crash cart. The lab technician stated that the patient was talking normal with no complaints to her and all of a sudden, she stopped talking and fell back into the bed. Within a couple of minutes the room was swarming with it seem everyone trying to resuscitate this patient. After an hour of resuscitation attempts, the ER physician called the code. We were all in shock and no one could figure out what happened. Personally, I quickly reviewed all my assessments of this patient trying to look for anything I might have missed. It wasn’t until a month later I found out that via an autopsy that the patient had had a massive heard attack and there that no way anyone could have know this was going to happen on that very morning. Oh, yes the valium had no relevance in this patient’s death.

Again, good nursing assessment skills are vital in the care of our patients. Someday, this could mean that your precious nursing license may be on the line as well. Doing the best nursing assessment at all times is vital in the life of every patient we have been entrusted to care for and should be utilized at every opportunity in the attempt of providing the best care possible for the good of all.

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2 Responses to “Nursing Assessment Liability, comment”

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