On the Other Hand
A young woman with Takayasu’s arteritis presented to the hospital with severe abdominal pain. The patient had been diagnosed with Takayasu’s a decade earlier. The disease results in arterial stenosis, which can cause ischemia in a variety of organs. One of the diagnostic clues is differential blood pressure (BP) in both arms (if there is more arteritis in one of the arm arteries than the other), and in fact the patient had been noted in the past to have very different BPs in her right and left arm. This had been recorded in her chart but was not noted in her hospital room or on her person.
The patient was admitted at 6:00 p.m. to the intensive care unit (ICU) for monitoring, pain medication, and intravenous (IV) hydration, in preparation for vascular surgery the next morning. The IV, with normal saline, was started in her left arm.
During the night shift, the midnight BP measurement using the right arm revealed a very low pressure (approximately 70 systolic). The nurse notified the covering resident, giving him a concise description of the patient, her primary admitting diagnosis, the surgery plans, and a report of the vital signs. The resident, who had been given only a brief signout on the patient (that did not include the history of different BPs in the two arms), was quite worried about the hypotension and ordered Levophed (norepinephrine), a powerful IV pressor. He did not examine the patient – if he had, he would have found that her mental status was normal, which might have been a clue that the true BP was not as low as the reading. The nurse took the resident’s verbal order for the medication and administered the drug.
Based on the above data, what critical information which should have been shared with the resident at signout and when the nurse contacted the resident?
Based on the above data, the nurse should have shared with the resident the diagnostic clues relative to the fact that the patient has differential blood pressure in both arms. The nurse could have also ensured that the information recorded in the patient’s chart is also noted in her hospital room or even on the person.
What factors could have contributed to the failure to recognize the potential critical nature of the situation?
The factors that contributed to the failure to recognize the potential critical nature of the situation is based on the fact that there was no adequate information provided on the condition of the patient. Secondly, there was no proper communication between the nurse and the resident on how BP has been found to indicate on the patient’s body. Third, the resident did not take time to analyze the situation of the patient before providing any advice on what medications to administer.
Who else should have been included in the interprofessional collaborative team in this situation and why?
The other person that should have been included in the interpersonal collaborative team in this situation is the patient. This is based on the fact that various doctors and nurses will work on diverse procedures on the patient’s body, but if there are no records left, the doctor or nurse in charge can get the relevant information from the patient before and medical processes are undertaken.
When the surgical team arrived in the morning, they were puzzled by the low BP (since the patient appeared to be otherwise stable) and asked that the BP be reassessed, once in each arm. When the pressure was measured in the left arm, it was noted to be within normal range, even as the pressure in the right arm was still very low. The team immediately discontinued the pressor order, believing that the patient’s true BP was the one from the left arm, and that the right arm reading was due to local vascular narrowing. Although giving a vasoconstriction medication to a patient with narrow blood vessels could have had catastrophic effects, no adverse outcomes were noted in this case.
It was clear that the resident did not have familiarity with the patient and the diagnosis. What is the responsibility of the nurse in conveying critical information to members of the healthcare team who lack the details of the patient?
The responsibility of the nurse is to ensure that there are clear records on how various processes are being undertaken in the body of a patient. It is also significant that the nurses develop good communication skills and understand how to relay information to the healthcare team, as this will help improve operations undertaken in diverse departments in the hospital.
From a systems perspective, what barriers may have been present which contributed to this situation?
From a systems perspective, the barriers that may have been present which contributed to this situation include communication barrier. The primary reason is the fact that there was no proper channeling of information between the nurse and the resident either through verbal or written communication.
Who are the best sources of assessment information?
The nurses are the best sources of assessment information.
What are your recommendations needed to change the potential problems which can occur when a lack of access to critical information and system barriers contribute to communication/collaboration failures?
My recommendations needed to change the potential problems which can occur when a lack of access to critical information and system barriers contribute to communication/collaboration failures is to the managers, who should ensure that stern measures are developed and implemented to improve the communication between the health care professionals in various departments. The process will help improve the level of accuracy in handling diverse issues faced by the staff, managers and even the clients to the hospital. Proper communication channels should also be implemented, which will help ensure that all data and information has been relayed through the right persons.