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If your ED patient sustained a few rib fractures, would you expect this to lead to rapid respiratory decompensation, pneumonia, and death? Minor injuries can have profound effects in the elderly, warns Avery Nathens, MD, division head of trauma and general surgery at St. Michael's Hospital in Toronto, Canada.
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If ED nurses believe a patient poses a risk of harm to themselves or others, a patient safety checklist is used for "closed-loop" communication with security, says Alexandra Penzias, RN, MEd, MSN, CEN, clinical nurse educator in the department of emergency medicine at Tufts Medical Center in Boston, MA. "This ensures that all members of the ED team are aware of the patient's status and plan of care," she explains.
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Is a cardiac-arrest patient failing to wake up and follow commands? "Therapeutic hypothermia is one of the few therapies we can offer," says Marion Leary, BSN, RN, assistant director of clinical research at the Hospital of the University of Pennsylvania's Center for Resuscitation Science in Philadelphia.
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Editor's Note: This is a two-part series on medication safety for inpatients being held in the ED. This month, we give strategies to reduce errors with inpatient medications. Last month, we gave strategies to avoid missed dosages.
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Before ED nurses at Ridgeview Medical Center in Waconia, MN, administered tissue plasminogen activator (tPA) to a man in his 80s with obvious stroke symptoms, the neurologist was consulted and also the patient's family members, says Kathie Pulchinski, RN, ED nurse manager.
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Do you treat elderly patients waiting in the ED as you would expect your own family member to be treated as if they were the only ones there?
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Developing personal relationships with ED patients involves ethical, as well as possible legal implications, says William Sullivan, DO, JD, FACEP, director of emergency services at St. Margaret's Hospital in Spring Valley, IL, and a Frankfort, IL-based practicing attorney. "Some ethicists have questioned whether it is wise to merge one's social and professional lives," he adds.
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If an emergency physician (EP) continues to treat a patient after a social relationship has developed, he or she faces significant legal risks, according to Jennifer Lawter, RN, JD, vice president of risk management at EPMG in Ann Arbor, MI.
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After the emergency physician's (EP) preliminary reading of a seizure patient's X-ray was negative, the patient was discharged, but the following day, the radiologist's report showed compression of the spine.
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If you have a conflict with a colleague, do you document only facts and objective observations or accusatory statements such as, "Despite my intervention, the doctor refused to acknowledge what I am telling him?"
