Nurse Case Study: ICU Charge Nurse allegedly failed to
monitor a critical patient and escalate treatment
Medical malpractice claims may be asserted against any
healthcare practitioner, including nurses. This case involves a registered
nurse working in the Intensive Care Unit (ICU) as a Charge Nurse.
A 50-year-old male was recently in reasonably good health,
although he had recently received a diagnosis of thyroid cancer. He was
divorced and shared custody of his teenage son. He had a very active lifestyle
and social life.
On October 19th, he underwent a total thyroidectomy and neck
dissection. The surgery was uncomplicated, and he was discharged home on
October 21st. On October 22nd at 12:45 a.m. the patient presented to a local
medical center’s emergency department (ED). He reported that he had heard a
“pop” in his neck about 40 minutes earlier, following which he developed neck
swelling and began to experience difficulty breathing.
At the time of the patient’s arrival, the hospital was
experiencing a high volume of patients. In fact, due to the volume of patients
the hospital was using locum tenens physicians and agency staff nurses to help
cover the overload.
The patient was admitted to the Intensive Care Unit (ICU)
due to the risk of suffering from a post-thyroidectomy hematoma. The patient
was admitted by his surgeon but requested the ICU hospitalist oversee the
patient care for the night. An agency nurse (co-defendant) was assigned to the
patient. The hospitalist (co-defendant) was with the patient from 1:01 a.m.
until 1:21 a.m.
After assessing the patient, the hospitalist left the ICU
and went to the on-call room to take a nap. Shortly after the hospitalist left,
the patient’s nurse spoke to the ICU Charge Nurse (insured) relaying her
concerns about the patient’s care. She felt the hospitalist should be doing
more for the patient instead of taking a “wait and see” approach. Over the next
20-25 minutes the patient became increasingly anxious and short of breath.
The patient’s nurse contacted the hospitalist and let him
know that the patient appeared to be decompensating, was having difficulty
breathing and becoming extremely anxious. The hospitalist gave an order for
intravenous lorazepam (1:36 a.m.) and monitor the patient’s response. The nurse
did not feel comfortable with the order, so she again relayed her concerns to
the Charge Nurse.
The Charge Nurse instructed the nurse to proceed with the
lorazepam and she would contact the hospitalist and tell him to come see the
patient. The Charge Nurse called the hospitalist and told him that he should
come see the patient. The hospitalist voiced frustration with the call and
stated that the patient was having an anxiety attack and the lorazepam would
help. The Charge Nurse disagreed with the hospitalist. She told him that if he
didn’t come see the patient, she would call the ED physician. According to the
Charge Nurse’s deposition, the hospitalist told her that the ICU staff were
incompetent and to “knock herself out” and call the ED. A few moments after the
lorazepam was administered, it became readily apparent that the patient was
headed toward respiratory distress.
The patient’s nurse called the Charge Nurse for assistance.
The Charge Nurse instructed the ICU secretary to call the ED and get an ED
doctor to come see the patient STAT. Within several minutes the
anesthesiologist and surgeon were both at the patient’s bedside. The
anesthesiologist was not able to intubate but bagged the patient while the
surgeon evacuated the hematoma in the patient’s neck.
Once the hematoma was evacuated, the anesthesiologist was
able to intubate the patient. The patient was emergently (via helicopter)
transferred to a higher acuity hospital for further treatment. He ultimately
suffered anoxic encephalopathy during his time in the ICU when he was in
respiratory arrest.
The patient can’t use utensils, so he can’t feed herself,
can’t groom or perform any of his ADLs. He is able to walk short distances with
a walker but must have assistance. Because he has not being able to voluntarily
move his arms, he cannot propel a wheelchair. He can’t even use a wheelchair
with a joystick because that also requires voluntary upper extremity movement.
He currently lives in an assistive living facility near his son and friends. He
suffers from cortical blindness, has complete upper extremity loss of
proprioception and loss of balance and coordination. The patient continues to
make improvements, but his recovery is slow.
What point could the nurse have done something
differently? (Response needs to be 150 words).
Explain the importance of Chain of Command at the
bedside. Was the Nurse and Charge Nurse right in the actions that they took? (Response
needs to be 150 words).