Question

1.  How effective was the orientation process for ICU nurses at St. Dismas Hospital?

2.  What would have prevented this situation?

3.  How do you think Lawanda’s family felt?

4.  What are the steps to address this situation and decrease the damage to St. Dismas Hospital?

Case Information

Lawanda Person was a recent graduate of a BSN program. She had only one year of experience in medical–surgical units when St. Dismas Hospital hired her to be a staff nurse in the intensive care unit (ICU). The situation described in this case occurred during the fourth week of her six-week orientation. On that particular day, Lawanda’s assignment was two clients who had suffered anterior myocardial infarctions (MI); both were 48 hours post event. One of the clients was still on a ventilator. Lawanda was the medication nurse should a code happen during her shift. This meant that if there were a code, she would be the team member to give physician-ordered medications to the patient.

Just before her shift was to end, Lawanda’s ventilated client went into code. The code team arrived and began CPR. The code was proceeding for more than 20 minutes when the nurse behind her handed Lawanda a syringe. Without any further action, she injected the contents of the syringe into the IV line. Immediately, the patient reacted and his heart stopped. The physician pronounced the patient dead at 10:30 p.m. Lawanda felt sad that the patient died, but knew that she had done everything she could to save him.

After the code, the nurse supervisor completed the documentation and checked the procedures. She discovered that the patient had received the wrong medication! Apparently, there was a mix-up in the medication drawer, and the medication came from the wrong bottle. She immediately notified the nurse manager and the physician and began an investigation.

The next day at the beginning of her shift, the nurse supervisor called Lawanda into her office. The supervisor told Lawanda about a medication error during the code in which Lawanda participated. The nurse supervisor said, “You killed a patient last night. You were the one who was in charge of the meds and you did not check them. You are going to lose your license over this.” She told Lawanda that she must call and report herself to the state board of nursing. In addition, she might be subject to fines and jail time for the medical error she had made. The nurse supervisor also threatened to put her on suspension. Lawanda reacted to this news with shock and grief, but the supervisor told her to “get some backbone” and finish her shift.

Lawanda went back to the ICU and, at the first chance she could, called her parents to tell them what had happened. They told her that they would do whatever they could to help. However, this did not make her feel better. Lawanda could feel the cold stares of the staff who would not speak to her during the shift. She tried to be attentive to her patients, but the supervisor’s words echoed in her head. She was a murderer! She might go to jail! She began to imagine what was going to happen to her during a full investigation of the event and how her mistake was going to cost her everything she had.

Somehow, she made it to the end of her shift and then she made her decision. She went to the medication drawer, took a bottle of potassium and a syringe, and put them in her pocket. On her way out of the lobby, she entered the restroom, locked the door, and gave herself a fatal dose of potassium. The housekeeper found Lawanda’s body later that evening and the emergency department responded; it was too late. Someone called the chief executive officer (CEO), who made the necessary notifications including the hospital’s attorney. He also called Lawanda’s parents. Understandably, they were shocked and angered by the news and accused St. Dismas of “killing our daughter.” Soon after this conversation, Lawanda’s parents contacted their attorney and alerted the press.

Answer 1

Answer: The orientation program was didn't go well as on that day the nurse Lawanda unintentionally given wrong medication to the patient which causes fatal result for the patient and he died.

Now adays medical error is one of the major cause of the death in the healthcare organisations. Medication negligence also contribute to the same. If nurse and the healthcare professionals are much attentive then this kind of situation can be easily avoided. Medicines should be kept at proper place and medication negligence should be avoided at any cost.

The Lawanda's parents were shocked and angered as they have lost their daughter. This is the greatest sorrow for them. Proper investigations as well enquiry should be done of this case according to the act.