1. read the narrative below decribing a scenario that occurred in a hospital emergency room
- individual error
- workplace environment/culture
- institutional/systemic problems
James
is an ER triage nurse at a local hospital. On Monday January 4th, 2021, James reported to work as usual at 7:00am. On this
particular, he was working with his RN colleague Melissa, who had to take a double
shift because Richard (the RN who typically works Mondays) was ill. At roughly
8:30am, a patient by the name of Charles Becker entered the ER, grasping his
right shoulder. He approached James’ desk.
“Hi
there,” remarked Charles, who was seemingly in pain.
“Hi.
What brings you to the ER?” asked James.
Charles
explained that he was involved in an accident at home whereby he fell from his
porch and landed on his shoulder, which he thinks is now dislocated or broken.
“Ok,
let me take your temperature and blood pressure,” said James, preparing the
instruments.
“Nurse,
can I please have some Tylenol or something. It really hurts,” inquired
Charles.
“I
will go double check with the doctor,” assured James. “No fever, so that’s
good. Your blood pressure will show in a second”
Just
then, Melissa joins them in the room, hunting intently for her eyeglasses that
she left there earlier.
“Hey
Melissa,” says James, “do me a favour and record Charles’ blood pressure. I
have to quickly ask the doctor something.”
Rushed,
Melissa notes 133/88. It actually read, 188/98. Normal blood pressure is
roughly 120/80. She then remembers leaving her glasses in the bathroom when she
washed her face.
“Hey
Doctor Fleming,” says James. “Quick question for you. There’s a-“
“Mr.
James,” Doctor Fleming interrupts, “do you not see that I am reading an MRI
report? As a nurse, you should recognize the importance of not distracting us
physicians when doing important duties such as these.”
James
is furious and embarrassed at the same time. He remains silent and begins to
walk away.
“Wait,”
Doctor Fleming remarks. “What is it now that you are here?”
“An
ER patient is requesting medication for pain. Looks like he dislocated his
shoulder. Can I give him anything in the meantime?”
“Acetaminophen
is fine James,” responded the doctor. “I am going to go speak with the
radiologist upstairs for a minute. I’ll be back in a few.”
James
returned to the triage area. He gave Charles two extra strength Tylenol caplets
and a bottle of water. Charles returned to the waiting room.
After
15 minutes, Melissa calls out, “Charles, you are next.” Charles rises from his
chair and quickly collapses to the ground. He begins to violently seizure.
Melissa
runs towards Charles, calling out “James, get over here please.” James joins
Melissa with some medical instruments to attempt to settle Charles.
“What
the hell happened?” James claims, as he straps the blood pressure machine cuff
on Charles. “195/125! He is in hypertensive crisis! How can this be? Melissa,
what was his bp earlier?”
Melissa
responds, “I don’t remember exactly, but something stable like 130/85. Wait,
let me just check the machine’s memory data.” 188/98.
“If
it was that high to begin with, then… oh no… the Tylenol! Acetaminophen will
increase blood pressure,” James stated with fear in his voice. James and
Melissa knew that Charles needed medication to quickly lower his blood pressure
before any organ damage began.
“Okay,
I’ll get Doctor Fleming in the back,” Melissa remarked.
“He’s
not there. He went upstairs to radiology. We don’t have time Melissa. Just get
the clonidine and captopril now!” yelled James.
Melissa
stuttered, “B-b-b-but James… we can’t. You know that… I mean, look what just
happened because we didn’t double-check.”
Just
then, Doctor Fleming turned the corner from the elevator exit. He ordered the
administration of clonidine and captopril. Charles came out of the seizure and
was immediately admitted for continued care.