3 Discussion Replies.
I need support with this Nursing question so I can learn better.
Reply to 3 Discussions (100 Words ecah). Give References to each And Use American Medical Association (AMA) style is accurately and consistently used for in-text citations and references
In scenario 10-B, a patient named Jack Jones was to be transferred from an ACO hospital to a rehab facility. The transport service from the rehab facility was scheduled to pick him up at 12:30, however, it didn’t show up until 2:30. Once Jack arrived at the rehab facility, his nurse noticed that he was prescribed for an antibiotic, but the entry was for a muscle relaxant.
The first ethical issue with this situation is that Jack was sitting in a hard stretcher outside for two hours for the transportation to show up. This is a very serious issue as Jack was left unattended for such a long period of time. Not only was he left unattended, but the hospital staff was expecting him to get picked up two hours before he was actually picked up, which means there is a good chance that they were unaware that he was still left there by himself.
The second ethical issue to occur in this scenario was the near-miss medication error. Had this error not been caught by Jack’s new nurse at the rehab facility, Jack would have been prescribed the wrong medication. This would be an example of medical negligence and could have caused more harm to Jack. According to the article, “If a Doctor Prescribes the Wrong Medication, is it Malpractice?” if a patient suffers as a result of medical negligence, a lawsuit can pursue and the trust between a patient and his or her doctor could start to break.3
The errors in transitioning a patient lie in communication. According to Patricia Dykes and her colleagues, “Communication gaps in care coordination, care transmission, and the content and reliability of information transferred across settings have been identified as threats to patient safety.”2 From Jack’s medical records to Jack himself, every aspect of the transition of a patient from once facility to another needs to be monitored closely.
One process that help resolve these ethical issues is the use of Longitudinal Care Plan (LCP). This plan is centered around a patient and keeps track of their treatment plans and goals.2 Through the use of electronic systems, information from a patient’s LCP can be displayed making it easier for the patient’s family or provider to track the progress of the patient’s wellness and treatments.
According to the article “What is Palliative Care,” palliative care optimizes the quality of life by anticipating, preventing, and managing suffering of patients that are terminally ill. Palliative care is always appropriate and should always be followed to help those who are fighting really tough diseases as it is designed to help them. Life prolonging treatments and palliative care are compatible because where life prolonging treatments are used to combat disease and illness, palliative care manages and plans what treatments should be used and when.
1) What is Palliative Care. CSU Shiley Institute for Palliative Care. https://csupalliativecare.org/palliativecommunity/what-is-palliative-care/. Accessed February 27, 2020.
2) Dykes PC, Samal L, Donahue M, et al. A patient-centered longitudinal care plan: vision versus reality. Journal of the American Medical Informatics Association : JAMIA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215040/. Published 2014. Accessed February 27, 2020.
3) If a Doctor Prescribes the Wrong Medication, is it Malpractice? Dickerson. https://www.dickersonoxton.com/doctor-prescribes-wrong-medication-malpractice/. Published April 4, 2016. Accessed February 27, 2020.
In scenario 10-B, we are introduced to a patient named Jack Jones. He is scheduled to be moved from a hospital to a rehab facility but encounters a few complications along the way. The first set-back he encounters was that the ambulance that was to transport him was 2 hours late, which leaves him to wait on a stretcher by the exit are for that entire time. Once he arrived at the rehab facility the second debacle in his care occurred. The medication that the physician prescribed him does not match the medication entry in his paperwork. The nurse contacted the physician and the error got resolved. There are several ethical issues in this scenario.
- The first ethical issue is that there was clearly an error made in the transportation process that lead to Jack having to wait on a stretcher for the ambulance. There isn’t necessarily an ethical issue in the ambulance being late, as that could be attributed to many things such as mechanical problems or an emergency that needed the ambulance. However, there is an ethical problem with how Jack was treated during that time. Timing of care is important to high quality healthcare and is necessary for the patient to be able to trust the physician as well as the rest of the healthcare team 2 . The second ethical issue was that Jack’s care plan had conflicting data entries. This is certainly a breach of the principle of non-maleficence, because Jack could have been given the wrong medication and the consequences could have been dire.
- The errors in transitioning the patient lie in that there should have been more communication between the care team and the patient as to what the problem was and how the care team planned on resolving it. Whether that be moving him back to a bed or taking steps to get another ambulance there to pick him up, the patient should always be informed in order to respect their autonomy. Leaving a patient on an uncomfortable stretcher for hours at a time does not reflect quality care. The medication error lies in a lack of attention to detail on behalf of the individual who entered the data. This error could be corrected by having a second person review the data prior to it being submitted or a program that ensures that the prescription and the medication entry fields on the paperwork are identical.
- An ethical resolution to the ethical issues could be that the hospital makes all the errors in medical care known to the patient, and to formally apologize. Perhaps the hospital could cover the costs of the medication that was in question and the cost of the ambulance ride. This transparency would lead to more trust between the patient and the healthcare team as well as promote the patient’s autonomy in their care.
In scenario 11-D, we are introduced to Mrs. Harris, who has metastasis of breast cancer to brain and bones. After going through a period of confusion due to her illness, she regained the ability to make decisions and her doctor urged her to fill out an advance directive. The advance directive gives guidelines for her future medical care in the case that she is unable to make the decisions. She advised to continue to receive treatment to potentially prolong her life but also does not want to be on a feeding tube or be resuscitated. She also advised that the care team aggressively manage the pain that is associated with her symptoms.
- The only case in that palliative care (symptom control and comfort rather than a cure) is not appropriate in this scenario, is the extremely unlikely event that there is a lifesaving treatment option that is not compatible with the pain management. Otherwise, all efforts should be made to provide palliative care while continuing to provide potentially life prolonging treatment.
- Palliative care and life-prolonging care are not incompatible or mutually exclusive. Only in the extremely unlikely event highlighted in question one would the two be incompatible. Otherwise there should be no reason not to provide both at the patient’s request. However, it would be unethical to provide life-prolonging treatment if the results were known to be the suffering of the patient with a significant loss to their quality of life, overall. The management of pain and attention to the comfort of the patient is crucial in this scenario.
- The physicians should document their intentions to provide palliative care by having the patient fill out an advance directive (as done in the scenario) to give the patient autonomy and allow them to make the decision about their care. This will show that the doctor is providing patient centered care by following the wishes set fourth by the patient.
1. Harman L, Cornelius F. Ethical challenges in the Management of Health Information, 3rd Edition. 2017: 271-314.
2. Braddock CH, Snyder L. The Doctor Will See You Shortly. The Ethical Significance of Time for the Patient-Physician Relationship. Journal of General Internal Medicine. 2005. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490262/ (Links to an external site.)>
Scenario 10-B Patient Transfer
In this scenario, a patient named Jack Jones is being transferred from a community ACO hospital to a rehab facility. Throughout this process there are several ethical issues that could have caused Jack pain, and possibly harm. The first ethical issue was during Jack’s physical transfer from ACO to the rehab facility. Jack was forced to wait in the exit area on a hard stretcher for two hours, waiting for an ambulance to arrive. The second issue was in regard to Jack’s prescribed medication. The ACO physician had prescribed Jack Norfloxacin, an antibiotic. However, the nurse noticed the patient entry had Norflex described, a muscle relaxant. The website www.goodrx.com (Links to an external site.) has fever listed as a possible side effect of Norflex.
Not only is this medication not suited for Jack’s current condition, it could have caused even further harm. In 2019 a patient died from fluid buildup in her lungs after incorrect medication requirements were communicated over phone to receiving pharmacy (Fink, 2019). This mistake is in violation of the nonmaleficence biomedical principle, to do no harm. The hospital should have taken more initiative in scheduling the ambulance and processing Jack’s medical requirements.
To solve these ethical issues, hospital management could review the hardships and mistakes Jack endured with the NAHQ code of ethics. Two principles in NAHQ’s code of ethics that relate to this scenario are patient safety, and performance and process improvement (NAHQ, 2019). Jack should not have been forced to wait in the exit bay for two hours, this is a violation against his privacy, and most likely an extremely uncomfortable situation for him to be in. Second, Jack’s medication should have been properly prescribed from its inception. Perhaps the hospital can enact a “second look” policy, where a second set of certified eyes verifies the patients status and signs off on the correct medication.
Fink. “Family Cannot Seek Damages After Patient Dies Due to Wrong Medication.” Pharmacy Times, 2019, www.pharmacytimes.com/publications/issue/2019/september2019/dispensing-wrong-medications-leads-to-patients-death (Links to an external site.).
NAHQ. “National Association for Healthcare Quality (NAHQ).” NAHQ, nahq.org/about/code-of-ethics.
Scenario 11-D Palliative Care
“Palliative Care is for any patient with a chronic life-limiting illness and could be provided throughout the course of an illness” (Mulvihill, 2014). Palliative care is normally decided upon by the patient or their family. A medical professional must respect a patient’ s spiritual and religious beliefs at the time of administering care (Richardson, 2014). These beliefs can be more important to the patient than the benefits of palliative care.
Palliative care is often mistaken with hospice care but can be administered even during treatment of illness (GetPallativecare.org, 2019). Physicians should be extremely transparent when recommending palliative care to their patient. The risks and side effects of the medication and treatments should be understood by all parties involved. This is an example of the bioethical principle, beneficence.
Palliative care is administered to aid a person during life-limiting illnesses to cope with pain and benefit the patient. It’s the physician’s job to be caring yet informative throughout the whole process. The physician should appoint a surrogate decision maker when proving palliative care (Balaban, 2000). It will be this individual’s job to make the hard decisions when the patient is unable to. Finally, the physician should identify lifesaving and prolonging resuscitation options, and have the process agreed upon by either the patient, or surrogate decision maker upon its time of need.
Mulvihill. “Palliative Care? But I Am Not Dying!” Emmi, 2014, www.emmisolutions.com/resource/blog-palliative-care-but-i-am-not-dying/ (Links to an external site.).
“Palliative vs. Hospice Care – Frequently Asked Questions.” Get Palliative Care, getpalliativecare.org/whatis/faq/.
Richardson, Patrice. “Spirituality, Religion and Palliative Care.” Annals of Palliative Medicine, U.S. National Library of Medicine, July 2014, www.ncbi.nlm.nih.gov/pubmed/25841692.