Mr Max Sheppard is a 64 year-old man who underwent a laparoscopic cholecystectomy at the large metropolitan Springfield hospital on the morning of 21 May 2013. Mr Sheppard was transferred to the Extended Day Only Unit (EDOU) at 1430 hours following the procedure. Mr Sheppard was to stay in the EDOU overnight with discharge planned for the following morning (22 May 2013).
A Medical Officer (MO) assessed Mr Sheppard at 1630 hours on 21 May due the patient reporting abdominal pain and distension. Mr Sheppard’s distended abdomen and pain levels were documented in the patient’s health record by the MO and a phone call was made to report this information to the surgeon who performed the procedure. Analgesia was prescribed (10mg morphine SC) at 1715 hours to be given PRN 6 hourly in response to the patient’s reports of pain.
Ms Sally Price was the RN working on the 12-bed EDOU with an Enrolled Nurse (EN) on 21 May. Ms Price had been registered as a nurse for five years. As per hospital policy, Ms Price and the EN were the only two staff members rostered to the unit on night-shift that commenced at 2245 hours.
The EDOU was at capacity on the night of 21 May. Two of the other male patients
admitted to the unit were distressed; one was continuously vomiting post-appendectomy and the other was experiencing urinary retention following a Transurethral Resection of the Prostate (TURP). There was also a female patient admitted to the unit who was very upset at being placed in a room with male patients due to her religious beliefs. This patient, who had very limited English language skills, was continually wailing and expressing anger over the fact that hospital management had not resolved this issue as promised to the patient and her husband on the afternoon shift.
It was hospital procedure that staff in the Post-Anaesthesia Care Unit (PACU), located adjacent to the EDOU; assist the EDOU staff when needed. The RN in-charge of the PACU on night-shift was required by hospital policy to ‘regularly’ check by phone with the EDOU RN to see if assistance was required. There was no such request made for assistance by Ms Price on the night of 21 May despite the fact the in-charge of the PACU reportedly contacted Ms Price five (5) times throughout the shift.
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