When was the last time you spent time in a hospital ward looking closely at the physical condition of the building?
Did you notice the chipping paint? The peeling wallpaper? The cracks in the floors? The stained ceiling tiles? The upholstery that was worn thin and so stained it can't be cleaned anymore? The blinds that are missing slats and won't open or close? The curtains that are worn and stained? The bed linens that are stained? The clutter of equipment in the hallways and rooms?
I notice these things every time I step into the hospital ward I work on. I do my best to make sure stained linen is changed before my patient ever goes near the bed. That stained curtains are taken down and replaced. But it is impossible to hide the deterioration of everything else.
The patients who are admitted to hospital are acutely ill or requiring some immediate intervention. Mothers are arriving to deliver their babies. The physical environment should be one of impeccable cleaniless and condition. Yet Canadian hospitals are often falling far short of this standard under the guise of fiscal restraint. Even if the money would be spent to restore the units, there isn't any place to physically put patients while the work is done.
Can a hospital defend its infection rate and care when it can't provide patients with an environment that promotes health and healing?
Showing posts with label lnc. Show all posts
Showing posts with label lnc. Show all posts
Sunday, June 28, 2009
Thursday, June 18, 2009
Changes to Care for Moms with Breech Pregnancies
The standard of care in Canadian hospitals since 2000 has been to deliver all breech babies by caesarean section. This method of delivery was based on solid research which showed the risks for potential harmful outcomes to the baby were too high for vaginal delivery. The Society for Obstetricians and Gynegologists of Canada has recently announced that this standard care will be reversed.
It is a basic premise of mechanics. The largest part of a fetus is the head-- and breech babies have their heads delivered last. There is always a risk that the head will prove too large for the mother's pelvis which results in fetal death and dismemberment as well as major injury to the mother during attempts to save the baby.
The other harsh reality is that delivery with best outcomes for mom and baby requires genuine finesse and loads of experience-- neither of which is easily found in our latest generation of obstetricians. They haven't seen or done enough breech deliveries to be good at it.
As a labour and delivery nurse in her third decade of experience, I have seen the time where breech pregnancies were delivered without a c-section. I have also seen babies severely compromised in the process when the obstetrician is not skilled enough to do it.
Two issues present themselves in the world of medical liability:
1. Will mothers be completely informed and truly understand the risks their babies face? If a delivery goes very wrong during this period of attempting to reduce the c-section rate by any means possible, can the defence argue against years of evidence that planned c-section delivery is best for the baby's safety?
2. Thousands of women were not given the choice in the type of delivery. Does this mean they have grounds to question that lack of options should obstetricians return to vaginal delivery of term breech pregnancies?
Breech deliveries are high risk, even in the operating room babies can have a traumatic delivery, cases presenting themselves over the next few years will require specialized expertise to determine if every possible factor was considered before the method of delivery was determined.
It is a basic premise of mechanics. The largest part of a fetus is the head-- and breech babies have their heads delivered last. There is always a risk that the head will prove too large for the mother's pelvis which results in fetal death and dismemberment as well as major injury to the mother during attempts to save the baby.
The other harsh reality is that delivery with best outcomes for mom and baby requires genuine finesse and loads of experience-- neither of which is easily found in our latest generation of obstetricians. They haven't seen or done enough breech deliveries to be good at it.
As a labour and delivery nurse in her third decade of experience, I have seen the time where breech pregnancies were delivered without a c-section. I have also seen babies severely compromised in the process when the obstetrician is not skilled enough to do it.
Two issues present themselves in the world of medical liability:
1. Will mothers be completely informed and truly understand the risks their babies face? If a delivery goes very wrong during this period of attempting to reduce the c-section rate by any means possible, can the defence argue against years of evidence that planned c-section delivery is best for the baby's safety?
2. Thousands of women were not given the choice in the type of delivery. Does this mean they have grounds to question that lack of options should obstetricians return to vaginal delivery of term breech pregnancies?
Breech deliveries are high risk, even in the operating room babies can have a traumatic delivery, cases presenting themselves over the next few years will require specialized expertise to determine if every possible factor was considered before the method of delivery was determined.
Thursday, May 14, 2009
Critical Flaw Costs Lawyer Thousands
A critical flaw was discovered by a defending attorney after the plaintiff’s attorney had spent thousands of dollars bringing the case to discovery.
a. 25 yr old woman in third pregnancy with one living child; first pregnancy had a compromised outcome
b. Premature rupture of membranes at 34 weeks of pregnancy; stabilized and transferred to antepartum unit to wait for pregnancy to reach 36 weeks, a common practice at this time
c. Sudden onset of bleeding and pain at 35 ½ weeks; fetal monitoring shows fetal distress; to OR and baby delivered within 8 minutes of primary nurse entering patient’s room
d. Mother had significant blood loss but fully recovered; baby needed extensive resuscitation but died two days later
e. Claim was made against the primary physician, admitting physician, and primary care nurse. Basis of the claim was that the patient’s call for help was not answered for twenty minutes by primary care nurse. This was substantiated by the patient’s husband watching the clock on the wall of the room.
Two vital errors were made by the plaintiff’s attorney that could have been identified by a legal nurse consultant:
1. He did not ask the primary care nurse what her patient load was at the time of the incident. There had been layoffs on the unit at this time. The incident also occurred during a time of night when nurses commonly take a one hour break and patient loads can be heavy. On this night, the primary care nurse was caring for six triage patients, an early labour patient and two antepartum patients which she had told the nurse in charge was too heavy for patient safety. However, the primary care nurse was never obliged to give him this information during discovery.
2. He did not confirm the actual presence of a clock on the wall of the patient’s room for her husband to time the response time. This unfamiliarity with hospital layout and the custom of clocks on the walls of rooms in other parts of the maternity unit cost the plaintiff their claim against the primary care nurse and wasted the attorney’s resources in preparing the case as well as three hours in discovery with the primary care nurse.
a. 25 yr old woman in third pregnancy with one living child; first pregnancy had a compromised outcome
b. Premature rupture of membranes at 34 weeks of pregnancy; stabilized and transferred to antepartum unit to wait for pregnancy to reach 36 weeks, a common practice at this time
c. Sudden onset of bleeding and pain at 35 ½ weeks; fetal monitoring shows fetal distress; to OR and baby delivered within 8 minutes of primary nurse entering patient’s room
d. Mother had significant blood loss but fully recovered; baby needed extensive resuscitation but died two days later
e. Claim was made against the primary physician, admitting physician, and primary care nurse. Basis of the claim was that the patient’s call for help was not answered for twenty minutes by primary care nurse. This was substantiated by the patient’s husband watching the clock on the wall of the room.
Two vital errors were made by the plaintiff’s attorney that could have been identified by a legal nurse consultant:
1. He did not ask the primary care nurse what her patient load was at the time of the incident. There had been layoffs on the unit at this time. The incident also occurred during a time of night when nurses commonly take a one hour break and patient loads can be heavy. On this night, the primary care nurse was caring for six triage patients, an early labour patient and two antepartum patients which she had told the nurse in charge was too heavy for patient safety. However, the primary care nurse was never obliged to give him this information during discovery.
2. He did not confirm the actual presence of a clock on the wall of the patient’s room for her husband to time the response time. This unfamiliarity with hospital layout and the custom of clocks on the walls of rooms in other parts of the maternity unit cost the plaintiff their claim against the primary care nurse and wasted the attorney’s resources in preparing the case as well as three hours in discovery with the primary care nurse.
Tuesday, May 12, 2009
Nursing shortage is important to lawyers
A report issued by the Canadian Nurses Association shows that the shortage of registered nurses is expected to grow to 60 000 by 2022. The current absentee rate for RNs is twice as high as any other profession with an average of 14 days per year. Workload, short-staffed units, lack of basic equipment and large numbers of less qualified and less experienced staff are taking a huge toll on the skilled work force in Canadian hospitals.
"It gets to a point where you have nurses so tired that when one of their colleagues calls in sick, they just say: 'Give me a warm body' - regardless if he or she has the education." Personal care workers are heavily relied on in some regions. "We need (them), don't get me wrong," Linda Silas, President of the Canadian Federation of Nurses Unions said. "But for patient safety and quality care, you need the nurses around and we shouldn't jeopardize this because of the shortage."
There is also a noticeable shortage of doctors, pharmacists, and physiotherapists.
Why should this matter to a lawyer? Because when your client comes to you with their story of what happened to them in the healthcare system, you need to be aware of the dynamics of the environment in which the event(s) took place. What were the staffing levels at that moment? What were the qualifications and experience of the direct care givers as well as their supervisors? Was the care being given by a worker outside of their scope of practice? Was fatigue or illness a factor in the level of care being provided at that moment?
Legal nurse consultants are registered nurses who have hands-on experience with the healthcare environment. They know first hand how the level of care is affected by the dynamics of the unit and the people in it. Let their expertise and insight bring to light nuances of the case that could so easily be missed.
"It gets to a point where you have nurses so tired that when one of their colleagues calls in sick, they just say: 'Give me a warm body' - regardless if he or she has the education." Personal care workers are heavily relied on in some regions. "We need (them), don't get me wrong," Linda Silas, President of the Canadian Federation of Nurses Unions said. "But for patient safety and quality care, you need the nurses around and we shouldn't jeopardize this because of the shortage."
There is also a noticeable shortage of doctors, pharmacists, and physiotherapists.
Why should this matter to a lawyer? Because when your client comes to you with their story of what happened to them in the healthcare system, you need to be aware of the dynamics of the environment in which the event(s) took place. What were the staffing levels at that moment? What were the qualifications and experience of the direct care givers as well as their supervisors? Was the care being given by a worker outside of their scope of practice? Was fatigue or illness a factor in the level of care being provided at that moment?
Legal nurse consultants are registered nurses who have hands-on experience with the healthcare environment. They know first hand how the level of care is affected by the dynamics of the unit and the people in it. Let their expertise and insight bring to light nuances of the case that could so easily be missed.
Sunday, May 10, 2009
Top 5 Reasons to Have Legal Nurses of Canada on Your Team
Because of the legal nurse consultant’s expertise in healthcare-related issues, he or she can bring the following benefits to the litigation team:
1. Cost-effectiveness: The LNC critically analyzes the healthcare facts of a case and
helps the attorney select and manage cases. Many cases can be either rejected or
settled quickly by using the resources and knowledge of an LNC.
2. Resourcefulness: The LNC has access to a national network of healthcare and
professional resources and contacts. The LNC is well versed in the use of medical
libraries, medical equipment, and other resources.
3. Knowledge: The LNC has a thorough understanding of healthcare issues and trends
related to the entire litigation process. The LNC “speaks the language” of
physicians, healthcare providers, and patients.
4. Experience: The LNC has a background of clinical experience, which includes the
ability to interpret medical records, documents, and health science literature.
5. Advantage: The LNC is a relatively new area of expertise which means adding one to your legal team is an advantage during the legal process.
1. Cost-effectiveness: The LNC critically analyzes the healthcare facts of a case and
helps the attorney select and manage cases. Many cases can be either rejected or
settled quickly by using the resources and knowledge of an LNC.
2. Resourcefulness: The LNC has access to a national network of healthcare and
professional resources and contacts. The LNC is well versed in the use of medical
libraries, medical equipment, and other resources.
3. Knowledge: The LNC has a thorough understanding of healthcare issues and trends
related to the entire litigation process. The LNC “speaks the language” of
physicians, healthcare providers, and patients.
4. Experience: The LNC has a background of clinical experience, which includes the
ability to interpret medical records, documents, and health science literature.
5. Advantage: The LNC is a relatively new area of expertise which means adding one to your legal team is an advantage during the legal process.
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