Category archives for Blog

ANATOMY OF A CHEST PAIN CASE: WHAT ATTORNEYS MUST KNOW TO NAVIGATE THE MEDICINE – PART IV

Inferior Myocardial Infarction Complications When reviewing a case involving chest pain and a resultant diagnosis of Acute Myocardial Infarction an attorney should pay particular attention to the type/area of myocardial infarction the patient sustained.  An acute Inferior Myocardial Infarction has certain characteristics that set it apart from other infarcts.  While the Inferior Myocardial Infarction itself, […]

NURSE INTUBATES PATIENT AND IS BARRED FROM HOSPITAL….WHAT IF???

Around the year 2008 an agency nurse intubated a patient that was obtunded, had decreased respirations, and decreased oxygen saturation and was ultimately barred from the hospital….What If…that nurse had not performed the intubation and the patient had coded and died. The setting is a level one teaching hospital ICU that has a residency/fellowship program.  […]

MALIGNANT HYPERTHERMIA

I recently reviewed a case where the patient arrested during transport from the Operating Room and due to lack of documentation it was not initially clear whether the patient had been monitored during the transport.  I was asked to review the case to determine, essentially, if the standard of care had been breached during transport.  […]

NURSING ASSESSMENTS: FILL-IN-THE-BLANK, NARRATIVE, ACCURACY

The nursing assessment is an important tool not only for the nurse performing the assessment but as I tool to determine progress or lack of progress of a patient.  As a Legal Nurse Consultant reviewing the nursing record of a patient you also need to determine the accuracy of the assessments.  One might suggest that […]

Nursing Care: Responsibility and Potential Liability

Legally where does the responsibility of the nurse begin and end?  If an order that a physician writes causes harm to the patient and the nurse that followed through with the order had the knowledge and experience to know that the order could/would cause harm to the patient, does that nurse not bear some responsibility […]

JOINT COMMISSION: STROKE CORE MEASURES

The Joint Commissions Core Measures serve as a standardized assessment measure for care given in specific areas.  Despite widespread dissemination of the core measures, safety goals, and related quality guidelines, there is significant variation in their application across hospitals.  The reasons for this are varied but include differences in guideline familiarity, provider training, and tools […]

DOES IV INFILTRATION/EXTRAVASATION SUGGEST NEGLIGENCE?

I have had the opportunity to review quite a few cases that involved IV infiltration/extravasation and have been deposed in two of those cases.  But can one assume that all IV infiltrations suggest negligence on the part of the nursing staff caring for the patient? IV sites infiltrate every day through no fault of the […]

Teachers/Mentors/Preceptors – The Good, Bad, and Ugly

All of us have been in the position of being required to learn new things in life.  Hopefully life is a continual learning experience as we are never too old to grow.  But when in a new situation, what makes an environment rich with the fertilizer that will help you grow and what makes an […]

JOINT COMMISSION: PNEUMONIA CORE MEASURES

The Joint Commissions Core Measures serve as a standardized assessment measure for care given in specific areas.  Despite widespread dissemination of the core measures, safety goals, and related quality guidelines, there is significant variation in their application across hospitals.  The reasons for this are varied but include differences in guideline familiarity, provider training, and tools […]

Code of Ethics and Conduct for the Legal Nurse Consultant

As a professional, a registered nurse and Legal Nurse Consultant, I have strong feelings that those that have taken on a career as a registered nurse or Legal Nurse Consultant, demonstrate and own a strong ethical value system in both their professional and personal lives.  Ones’ behavior, professional and personally, impacts the reputation of the […]

JOINT COMMISSION: HEART FAILURE CORE MEASURES

The Joint Commissions Core Measures serve as a standardized assessment measure for care given in specific areas.  Despite widespread dissemination of the core measures, safety goals, and related quality guidelines, there is significant variation in their application across hospitals.  The reasons for this are varied but include differences in guideline familiarity, provider training, and tools […]

Joint Commission Core Measures Sets

The next few blog posts are going to address the Joint Commission Core Measures for various Core Measure Sets as related to specific medical conditions.  Whenever I am reviewing medical records for a malpractice case I utilize templates I have devised if possible.  These templates include a list of specifics concerning the cases particular medical […]

SO YOU ARE INTERESTED IN THE LEGAL NURSE CONSULTANT PROFESSION

You find yourself interested in the Legal Nurse Consulting profession and research educational programs that offer a pathway to a Legal Nurse Consulting Career. Following are some of the phrases you might see as you click on sites that offer Legal Nurse Consulting programs: Experience Total Financial Freedom!! Earn up to $150/hr.*as a Certified Legal […]

DILAUDID and POSSIBLE COMPLICATIONS FROM ADMINISTRATION

I have had an opportunity to review a number of cases recently where Dilaudid caused serious complications, including death. Dilaudid is not a drug to be given without knowledge of a patient’s previous narcotic exposure and serious consideration of Dilaudid’s side effects. Spurred by the 2001 Joint Commission on the Accreditation of Healthcare Organization’s pain […]

COMPLICATIONS POST PCI (PERCUTANEOUS CORONARY INTERVENTION)

Previously the nursing care post PCI procedure was discussed focusing on what a PCI is, vital signs and monitoring of the insertion site, and removal of the sheath. This post will address the complications that can occur prior to and after sheath removal, and the interventions to take if any of these occur. Hematoma This […]

So You Want to Subcontract for another LNC?

I belatedly decided to do some research on what to look for in a LNC when looking for subcontracting work. Interestingly I found quite a few links regarding what a LNC should look for in finding nurses to use as subcontractors, but I found nothing on the characteristics of an LNC one would want to […]

A Picture is Worth 1000 Words

I have had the opportunity recently to review two cases involving significant injuries stemming from an IV infiltration.  Both of these cases involved medications infusing peripherally that if at all possible should have been infusing via central access.  The documentation with both of these cases was also very confusing.  Some infusions did not have the […]

Nursing Documentation: Legal Ramifications

Nursing Documentation:  Legal Ramifications My experience as a clinical bedside nurse and a legal nurse consultant has proven to me that many nurses simply do not understand the medical and legal ramifications of poor, incomplete documentation.  Yes, the medical record is a document that, if not properly utilized, can lead to problems for the healthcare […]

MEASURING SUCCESS AS A LEGAL NURSE CONSULTANT

Success is measured very differently by each individual.  I have had quite a few people approach me recently asking for advice and guidance in the world of Legal Nurse Consulting.  Questions range from is this a realistic field to pursue; is there enough work out there; in what areas can a legal nurse work.  I […]

COMPLICATIONS POST CORONARY ARTERY BYPASS SURGERY

The literature differs on the prevalence of complications post coronary artery bypass surgery (CABG).  These complications include: Wound infection and bleeding Reactions to anesthesia Fever Pain Stroke, myocardial infarction, or even death Some patients develop a fever associated with chest pain, irritability, and decreased appetite. This is due to inflammation involving the lung and heart sac.  […]

THERAPEUTIC HYPOTHERMIA POST CARDIAC ARREST

In October 2002, on the basis of published evidence, the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation made the following recommendation: Unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours when the initial rhythm was ventricular fibrillation […]

DOES AN RN HAVE TO FOLLOW EVERY ORDER A DOCTOR WRITES? WHAT ABOUT MISSING ORDERS?

In reviewing files as a Legal Nurse Consultant one has to be acutely aware of the nurses’ responsibility in different scenarios.  Yes, physicians are held liable for writing inappropriate orders, inaccurate orders, and for not writing orders; but nurses, using sometimes simple knowledge and at other times specialized knowledge should know when to not follow […]

EMERGENCY RESTERNOTOMY

Emergency resternotomy is a special team skill that is required in a unit that has open heart surgery patients.  It is imperative that this team can work together seamlessly and with precision.  This ICU needs to be trained to assist with this procedure.  Also, due to the fact that the emergency resternotomy is not a […]

RESUSCITATION OF THE CARDIAC SURGICAL PATIENT

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Cardiac surgery patients are different from many other patients for a number of reasons when it comes to resuscitation post arrest. arterial line, Swan-ganz catheter (generally), and cardiac monitor; thus allowing for very early defibrillation without the use of external cardiac massage (ECM). ECM should be avoided if at all possible due to risk of […]