Introduction
The current paper reviews the case of Yolanda Pinellas, who reported on a malpractice action. During chemotherapy conducted with Mitomycin via intravenous (IV) infusion with an infusion pump, an incident occurred, which later led to necrosis of the hand. Notably, during the night shift, the pump signaled, and the registered nurse (RN) found the IV dislodged, stopped infusion, notified the physician, and provided assistance; the record indicated IV infiltration. The patient testified that the nurse only pressed the buttons on the device to stop the signal, but did not remember the details due to sleepiness. The risk manager found that the hospital had short-staffing issues and patterns of use of float nurses.
Advanced Practice Nurses (APNs) roles imply significant expertise and leadership skills, making them influential in healthcare settings. The current paper examines the role of the APN as an administrator in the case under consideration. Even though the RN states they provided the care, the staff violated the standards of practice and did not prevent the problem with the help of risk management, leading to complications for the patient.
Role of the APN and Standards Violation
APNs can perform a variety of roles within a healthcare establishment. They are leaders in patient-oriented care actions and organizational issues (Lamb et al., 2018). As administrators, APNs manage treatment teams, departments, or even an entire facility, ensuring uninterrupted and high-quality work (Nurse Journal, 2022). Health services must meet standards to support high quality, and APNs should support staff adherence.
The professional organization American Nurses Association (ANA, 2021) is one of the crucial sources presenting the Scope and standards of practice, which should guide nurses, including APNs. At the same time, maintaining standards of care is a flexible process that requires the nurse to be aware of potential harm to the patient and take action to prevent it (Westrick, 2014). Using ANA standards, one can determine which violation occurred in the case of Yolanda Pinellas.
The registered nurse (RN) violated the Assessment and Diagnosis standards because the employee did not see a potential threat of the medication leak. Moreover, the RN and APN broke the implementation and coordination of care standards, as they did not coordinate or discuss the necessary actions to ensure continuity of care after the incident to prevent complications. Within the framework of this standard, there was also a violation associated with correct information recording.
In particular, Mitomycin used for treating the patient is vesicant (Mieczkowska et al., 2021). As a result, the leakage of the drug would not lead to infiltration as recorded, but to extravasation. This error may also prove a lack of knowledge and, as a result, a violation of the standard of Assessment and Education by an RN.
The considered issue also indicates that the entire treatment team violated the communication and collaboration standards and the leadership standards of the APN since they could not discuss and cooperate to solve the problem. The standard of health teaching and health promotion was also disregarded, as employees had to inform the patient about potential complications and symptoms to observe to reduce risks (Kim et al., 2020).
The seriousness of the complication and the patient’s lack of knowledge about the employees’ actions indicate that the RN and the APN did not meet the standard. Moreover, ethical standards under which nurses must express primary commitment to their patients have been violated (ANA, 2015). Finally, the APN also broke the Quality of Practice and Professional Practice Evaluation standards. Evidence of their violation is that, knowing about the problem of staff shortages, they did not provide the necessary measures to optimize work and prevent risk.
Risk Management
Steps Before Incident
Risk management in administering dangerous drugs to prevent extravasation involves following existing guidelines. In particular, the APN administrator had to ensure that IV infusion was performed by a specialist who understood the properties of the drug and had the necessary skills and knowledge to administer it (Kim et al., 2020). This aspect is especially relevant if the RN who managed the problem during the evening shift was among the float nurses. Moreover, the administrator must make sure that the policy of patients’ records is clear since such extravasation incidents require details in the history, such as the description of symptoms, the place of leakage, sometimes photos, and other aspects (Kim et al., 2020). Proper APN and RN action could have prevented necrosis in the considered case.
Steps After Incident
Risk management also includes steps to respond to the incident accordingly. One of the critical actions is investigating the error, that is, the conduct of root-cause analysis (RCA) (McGowan et al., 2022). The administrator should ensure that the necessary policies are in place for the research and that the investigation is being conducted.
The next step involving the APN administrator is to identify opportunities to improve practice based on the results of the RCA. This measure implies the development of an improvement plan and managing the necessary resources for its implementation. Thus, the actions after the incident aim to prevent its repetition through improvements.
Conclusion
Thus, Yolanda Pinellas’s case includes a breach of several standards of care by staff, including the APN in the administrator role. APNs can significantly impact the practice of the entire facility or the employee’s team. In the considered case, the administrator had to ensure that a suitably qualified nurse administered and managed the dangerous drug. Moreover, the administrator establishes risk behavior policies, including maintaining patient records. After the incident, the administrator is responsible for initiating an investigation and developing an improvement plan.
References
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