Question

887 The Case of the Dishonest Employee Dale Buchbinder Dr. Jonas was examining a patient in the office who needed a dialysis access procedure performed on one of her arms. Dr. Jones reviewed the vital signs done by Ms. Smith, a med tech/secretary. Her documentation in the medical record clearly stated the blood pressure was equal in both arms. Dr. Jonas performed his own examination and realized that the radial pulse in the left arm felt diminished as compared to the right. After completing a thorough examination, he was still somewhat concerned by the discrepancy between the physical exams and the vital signs placed on the chart by Ms. Smith. He repeated the blood pressures himself. Sure enough, the systolic blood pressure in the left arm was 60 mm/hg less than the right. The patient's left arm would have been the preferred site to perform an access proce- dure because the patient was right-handed. Now it was clear only the right arm would be suitable unless another intervention was performed first. If Dr. Jonas had relied on the information placed in the chart he would have conducted an access procedure in the left arm. With a low systolic blood pressure in the left arm, the access would have been doomed to either failure, or given the patient's physical status, a severe complication such as steal. Since he was trying to sort through the facts and what happened, Dr. Jonas asked the patient if blood pressure readings were performed in both arms. The patient replied the pressure had only been taken in the right arm. way too much blood flow causing ischemia to Steal: A conditio the arm.

Answer 1

1.Important aspects of the case:

• Patient to be undergoing dialysis on either of the hand.
• Need to check through blood pressure of both the hands.
• Ms Smith nigligence of vital signs documentation.
• Dr.jonas found to have low diastolic BP in left arm.
• Can be the complication such as seal in carrying dialysis on the left hand.
• Patient information of BP checked only in right arm.
• Ms Smith acceptance of falsified data.

2. Theory of nigligence:

Failure to behave with the level of care that professional would have exercised under the same circumstances. The behaviour usually consists of actions but can also consists of omissions where there is some negligence to the act , as in this case of falsification.

3. The one carrying falcifacation of patient data should be dealt with strictly. Regulations should be in place to prevent its occurrence.

Action can be taken as

• Adopt zero tolerenceall suspected misconduct. All allegations must be thoroughly and fairly inveinvestigated
• Clarify how to report establish clear policies, guidelines related to misconduct and responsible conduct.
• Train the researchers to pay more attention to how they work with their juniour team members.
• Carrying internal auditing of research records.

4. Ms Smith can be suspended for a week with a soecific fine amount to be paid. Counselling is also an important role before Ms Smith rejoining the duty. Making her understand the disciplined way is very important in a health care settings.