Instructions: 1. This is a leadership and managment assignment. Review case study. Answer questions. Write a summary and upload a copy.

2. Envision being the RN experiencing the situation and comment on how you would handle the situation. Post focusing on leadership and management critical thinking and strageties. Class members reply to comments in “discussions”.

Nursing Now Case Study

Chapter 11: Communication, Negotiation, and Conflict Resolution

Case Study

Phyllis, a 72-year-old woman who developed slurred speech and weakness in her right arm and hand, was referred from her primary care provider’s office to a hospitalist for admission and evaluation of a possible TIA. Her admitting physical evaluation by the RN showed an elderly, but otherwise generally healthy patient. Phyllis’ admission lab tests were all within normal limits except for her CBC which showed a moderate degree of anemia. The hospitalist attributed this to a diet low in iron, which is not unusual among the elderly, and started her on an iron supplement during hospitalization. He also ordered a stool for occult blood because anemia can be caused by GI bleeding from ulcers and other illnesses.

Phyllis’ neurologic condition rapidly improved with anticoagulant treatment and physical therapy and she was discharged home three days after admission. The stool for occult blood test was never done by the hospital staff and went unnoticed by the discharging physician, who was different from the hospitalist who had admitted her. One of the discharge instructions from the RN for Phyllis, in addition to the use and side effects of anticoagulants taken at home, a high iron diet and iron supplements, was to contact her primary care provider for follow-up to determine the cause of the anemia. The discharging physician did not schedule an appointment with the primary care provider.

Ten days after discharge, Phyllis was admitted to the ER with severe abdominal pain, low blood pressure and a weak thread pulse. After an MRI of the abdomen, she was diagnosed with a ruptured intestinal diverticulum and major interabdominal bleeding.

She was immediately taken to surgery, where a section of her large intestine was resected and a colostomy was performed.

After reviewing her chart from her previous admission, her primary care RN asked

Phyllis if she had seen her primary care provider for the follow-up on the anemia, which may have detected the impending GI bleed and reduced the severity of the surgery. The client responded that she had called about an appointment and the office clerk had asked her if her speech and weakness were improved. After replying “yes,” the office clerk told Phyllis that all she needed to do was to keep her next routinely scheduled appointment in two months. The records from the recent hospitalization had not been reviewed by anyone at the office, and the primary care provider was not aware of the patient’s anemia that had been identified in the hospital.

Questions

• As with most patient errors, there was a chain of events that led up to the final result.

List the chain of events involved with the client’s case.

• Who was primarily responsible for causing the poor outcome in this case?
• If an RN Patient Safety Officer was reviewing this case, what sentinel events would he or she identify as needing risk reduction policies?
• What would you do to correct the events that lead to the poor outcome for Phyllis?
• What are the ethical issues involved in this case?