Case Study: Malpractice Action Brought by Yolanda Pinellas

Healthcare systems have long struggled to reduce the burden of inappropriate treatments which impair patient outcomes and increase expenditure. Issues like medical malpractice which result from inappropriate treatment can lead to increased costs and harm to patients (Dahlawi et al., 2021). In addition, malpractice is associated with higher insurance premiums for providers and a move towards defensive medicine which impairs quality care delivery. This discussion analyzes a case study involving medical malpractice to identify involved individuals, violated standards of practice, and appropriate risk management steps that can be taken.

Case Overview

The case of 21-year-old Yolanda Pinellas refers to a medical malpractice situation that leads to patient harm. The patient had received IV mitomycin via an infusion pump but it dislodged. Despite the registered nurses’ discontinuation of the infusion, infiltration occurred and the patient developed necrosis two weeks later. The patient underwent a series of surgical procedures, skin grafting, and reconstruction but ended up losing function in her third, fourth, and fifth fingers. Ms. Pinellas is now unable to perform as a musical conductor because of the incident raising concerns about medical malpractice related to the case.

Role of the Advanced Practice Nurses (APNs)

Advanced Practice Nurses (APNs) play a crucial role in ensuring high standards of care across various healthcare settings. These individuals practice clinically to assess patients and interpret diagnostic tests. The individuals have the role of utilizing evidence-based practices to ensure that patients receive the most effective and up-to-date treatments and interventions (Vaismoradi et al., 2020). APNs are directly involved in complex care management, health promotion, and disease prevention through various approaches. To ensure patient safety, APNs practice according to the standards of care and advocate for their patients’ rights, preferences, and needs.

Professional Portfolio: Professional Mission Statement

The case of Yolanda Pinellas demonstrates the violation of the patient’s rights by different healthcare professionals. The first individual involved in the violation of standards of care was the nurse who came in and silenced the infusion pump. The nurse violated the standards of care because he/she did not assess the patient’s safety and report any changes in the treatment process. The other individuals involved in the violation of the standards of care are the RN and the physician. It was documented that infiltration occurred but the two failed to provide adequate follow-up. The patient later developed necrosis after two weeks upon discharge demonstrating negligence of the care team.

The American Nurses Association (ANA) establishes standards of nursing practice to guide the professional responsibilities and ethical obligations of nurses in the United States. These standards are designed to ensure safe, competent, and ethical care for patients across all healthcare settings (American Nurses Association, 2015). The above case demonstrates a violation of certain standards of care mentioned by ANA. The nurse who checked the infusion pump and failed to stop the treatment violated the standards of care related to the implementation of care (American Nurses Association, 2015). This standard of care requires the nurse to use equipment responsibly, and assess, and monitor patients throughout treatment.

The second standard violated is communication by the RN and the nurse who silenced the infusion pump. This standard requires the provider to communicate effectively in all areas of practice with patients, families, and the greater medical team (American Nurses Association, 2015). Failure to communicate the initial error in medication administration to the RN and the patient led to the observed adverse event. The quality of practice standard was violated by the hospital given its failure to ensure adequate staffing and education of nurses. The RN may have met this standard at the individual level but the facility failed to provide a good environment for providers to practice safely.

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Risk Management Steps Before

The first step that can be taken to prevent the event before it happens is to improve communication between the providers and patients. Improving communication will ensure that the nursing team communicates during sentinel events and informs patients what to expect (Vaismoradi et al., 2020). The second step will involve designing a quality improvement initiative to educate providers about medication administration using infusion pumps and how to manage infiltration. Adequate patient follow-up upon discharge is another step that could be implemented to prevent such events. Adequate follow-up could have helped the patient to seek medical care earlier instead of waiting for the arm to be necrosed after two weeks.

Risk Management Steps After

In response to the actions leading to the malpractice case involving Ms. Pinellas, the APN should begin by apologizing to the patient. The second step will involve holding talks to see how the patient can be compensated instead of going to court. Another key step after the event is to design a quality improvement project that supports patient safety (Vaismoradi et al., 2020). The project will serve to educate nurses about the standards of care and how negligence can lead to malpractice lawsuits. Another key step will involve improving quality through adequate staffing in the facility. Improving staffing will ensure that nurses are readily available to monitor patient treatments and take necessary action before adverse events occur.

References

American Nurses Association. (2015). Scope and standards of practice nursing 3rd edition. https://www.nursingworld.org/~4af71a/globalassets/catalog/book-toc/nssp3e-sample-chapter.pdf

Dahlawi, S., Menezes, R. G., Khan, M. A., Waris, A., Saifullah, & Naseer, M. M. (2021). Medical negligence in healthcare organizations and its impact on patient safety and public health: A bibliometric study. F1000Research, 10, 174. https://doi.org/10.12688/f1000research.37448.1

Vaismoradi, M., Tella, S., A Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health, 17(6), 2028. https://doi.org/10.3390/ijerph17062028