When Outcomes aren’t Good Enough
Both charts involved psychiatric patients living in a congregate living situation with paid caregivers. They lived in different states and the living situations were different but the similarities are there, nonetheless which is why the second chart caught my attention.
In both instances, there was a ten day gap between the last visit and the time the patient went to the hospital and yet the schedules called for weekly visits. There were indications that it was not safe to push the visit back and possibly even a PRN visit should have been made. Both agencies – completely unrelated – had a policy that supervisors should be notified of missed visits and neither nurse followed the policy.
One nurse will stand before the board in defense of a nursing license and the other one will be scolded by yours truly.
The difference is not that one nurse took better care of the patient or that the patient’s condition was any better in one patient than in the other. The difference was dumb luck.
One patient died from a subdural hematoma. The other was treated and went back to the facility. The questions I have are:
- Did the nurses in each instance visit patients according to when it is convenient for them?
- If they were employed at a hospital, would they work whichever shift they chose?
- If a patient really doesn’t need to be seen but once every ten days or so, why not schedule the patient for every ten days?
- Could either nurse have picked up on something that may have prevented the hospitalizations?
Honestly, I don’t know. In fact, I sort of doubt it but who knows? And I am not the only one asking these questions.
In 15 years of of ICU work, I saw a lot of patients die. It never, ever felt right when a full code patient died on my watch. The sleepless nights, the endless record reviews, the self doubt all take a toll. After a while it got better because the brutal questions I asked myself are worse than any a malpractice attorney could ask. And honestly, not all of the answers were in my favor. I have made pretty much every mistake there is to make but luckily, nobody died because of them.
The nurse whose patient died will have a lot of questions that will never be answered because an assessment wasn’t made for ten days prior to the hospitalization. My deepest sympathies lie with that nurse.
What can you take away from this? Both nurses are guilty of exactly the same thing. Both put off a visit until later in the week, neither one called a supervisor and the polices of both agencies were ignored. Each situation had a radically different outcome which was likely beyond their control. Whether or not they saw their patients or notified their supervisor when they did not see the patients was clearly within their control.
Don’t be the subject of a future post. Follow your schedule. It is not a suggestion or a recommendation. It is what is expected of you from your patients, your employer and your state board of nursing.