RTT1 Task 2 Essay example

Lack of enough trained staff in conscious sedation available at the time of the procedure

We know that he had sustained an at home fall. We learn that he has a history of pain and a prescription for oxycodone for back pain. We know that his vital signs on admission appear stable; he was not showing any signs of respiratory distress. As we look at the staff that was listed that day we do get the sense the hospital may have been short staffed. Staffing report shows there was one MD, one RN and one LPN managing at least 4 patients including- one patient was a child. Evidence based research has proven that the nurse to patient ratio is directly related to the patient outcomes (Stanton, 2004). It is important that we consider the staffing level that this rural ED as we know short staffing can be blamed for not being able to take the full amount of time needed to do a proper health history. A detailed health history is an imperative part of the care process; it is used by the staff to accurately assess any acute changes that may take place in the patient throughout their stay.

A policy for conscious sedation was in place and not followed by staff. As all staff had been trained in the procedure, completed the appropriate modules, and

Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O ' Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since this time have focused on the influence of sedation protocols, and outcomes. This paper will review the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies. Also, explanations including a preliminary conclusion will be discussed.

The patient did have black soot around his nose and mouth. Thats when first responders started manual ventilation's via BVM and 02 at 15 LPM. At this time Medic 1 assumed patient care. Medic 1 assigned first responders to obtaining vitals signs that are stated in the vital section of the report. It was at this time that Medic 1 applied a OPA after first measuring on what size to use. First responders also applied fast patches to the patients right upper chest and left midaxillary line At this time Medic 1 assigned first responders to start chest compressions a 15:2 ratio. Medic 1 at this time started a IO in the patients plateau region of the right leg. The Plateau region is inferior and lateral to the knee cap. At this time Normal Saline bolus was started with a 60 drop per ML set. Medic 1 found the patient to be in a sinus rhythm At this time miscommunication with Medic 1 and first responders happen with chest comparisons started. We then secured the patient on the cot via 4 straps and transported a code red patient to the nearest hospital. While enroute to hospital radio report was given with chief compliant and treatments listed in the appropriate category of the report. Vitals was continued to be taken every 5

Dr. Jackson called back around 4:40 a.m. and ordered supplemental oxygen, blood work, and diuretic, and to maintain the patient’s oxygen saturation reading above 94 percent. Around 5:30 a.m., the patient’s respiration was still labored with 36-40 breaths per minute. Obeyesekere once again suctioned the patient that brought the patient’s oxygen saturation level at 95 percent. Meanwhile, at 5:30 a.m.,

These statements link the cause to its effects and then back to the main event that promoted the root cause analysis (Huber & Ogrinc, 2014). Guidelines for writing causal statements include the need for clarity in the relationship, statements should use neutral language and not imply blame, cause should be given for any human error, and any violation of procedure should also have a preceding cause (Huber & Ogrinc, 2014).

Mr. P’s vital signs and diagnostic studies are as follows: Blood glucose level 700mg/dL, Blood Pressure 90/60mm Hg, Heart Rate 128 beats/min, Respiratory Rate 34 breaths/min, Temperature 100.8 F, Serum pH 7.26, Serum HCO3 10 mEq/L, BUN 40 and Creatinine 3.5.

Many factors have contributed to the sentinel event, specifically the current conscious sedation policy. The improvement plan would include revising the conscious sedation policy to ensure the patient is properly monitored post procedure and to intervene when issues arise. The sedated patient should be monitored one on one post procedure by an RN, who is educated on the conscious sedation protocol, for thirty minutes or until the patient reaches his baseline. Also, mandatory monitoring will include EKG, pulse oximetry, blood pressure, heart rate, respirations and level of consciousness. A list of appropriate medications and the dosages should be included in the conscious sedation policy. In addition, reversal agents should be readily

In order to decrease the likelihood that such sentinel event will occur again, a change must be put into place. In this case, the change should involve the process in which conscious sedation is carried out as well as the knowledge of those providing care for those patients. The registered nurse in this case is most likely very good at her job, she probably felt that she had everything under control and has most likely provided conscious sedation many times in the past. As an experienced nurse, however, it is wise to understand that one should never become complacent and it is okay to ask for additional help, especially when a change in patient’s status can occur so quickly. And while this nurse is up to date on her sedation modules

The discharge criteria in the policy states the patient will be fully awake, vital signs stable, no nausea or vomiting, and the patient is able to void. All practitioners that provide moderate sedation must complete a training module prior to providing moderate sedation, this includes personnel assisting with the procedure. The first process failure was not meeting the required monitoring of the patient as mandated by the moderate sedation policy. In the absence of ECG or respiratory monitoring the sedation administered produced apnea then asystole without ED personnel being aware of acute changes in the patient’s condition. There is no explanation for why the patient was not on continuous ECG monitoring. Equipment was found to be in good working order.

Assessment: the patient 's vital signs are 108/68, 125 beats per minute, respirations, even and non-labored at 14 breaths per minute, 92% on 2 liters of oxygen via nasal cannula, afebrile 98.5 F.

Compliance data audit results for moderate sedation procedures from pre to post procedure uncover that most categories met the 90th percentile a majority of the time. This has a direct effect on the provision of care, treatment and services.

The first assessment of CB in the PACU revealed that she was still deeply sedated. The anesthesiologist almost had to administer Narcan to reverse her anesthesia because she was having such a difficult time waking up. She had clear breath sounds bilaterally and her skin was warm to the touch. Her initial blood pressure reading was 134/72. Her bladder was non-distended and her pain rating was 9/10 in her abdomen. An IV push of 2 grams of Dilaudid was given for her pain. Additionally CB was given Zofran for nausea. Specifically in the PACU the nurses are monitoring the patient’s airway, their pain, level of consciousness, any bleeding at the incision site, and nausea. CB was kept in the PACU, or stage I as it is referred to in the Surgery Center, for an hour until she was alert and able to breath on her own without a nonrebreather mask. Every patient is put on a nonrebreather and EKG when they arrive in stage I. Vitals are taken every five minutes times four, then once before they leave. There is a specific documentation

This case is about Mrs Sawyer, who is 70-year-old and admitted to the hospital as a result of fall align with a right neck of femur fracture. Linking back to the morning handover, Mrs Sawyer was day one post-op and received 1mg/ml of Morphine with a lock out period of 10 minutes via patient controlled analgesia (PCA). She was unsettled and complained of pain during the night. According to the PCA data from the night shift, Mrs Sawyer has tried to press the PCA button 20 times; however, adequate amount of analgesia was not being administered. In the morning, she indicated her concerns in regards to the side effects of Morphine, which resulted in her being reluctant to the PCA. As a result, Mrs Sawyer’s pain exacerbated at the surgical site,