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Practice Tip of the Week: Nurses Should Have Advocated for Orthopedist to Reevaluate the Patient

Tuesday, September 3, 2019   (0 Comments)
Posted by: Kanaka Sathasivan
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Preparing patients for discharge is an important role for nurses who have a duty to ensure discharge planning and education care are completed. Effective discharge preparations not only engage patients and families to address patient care needs will be met after discharge but also help them make informed decisions for follow-up care.

Evidence-based initiatives such as Project RED and RED Toolkit are useful resources. Research on missed nursing care identified discharge planning as among the most frequently omitted nursing tasks. 

This week’s practice tip is a response to a recent Texas court case in which the nurses and surgeon shared liability for a patient’s poor outcome. 

Reprinted with permission
Legal Eagle Eye Newsletter for the Nursing Profession
September 2019, Volume 7, Number 9

E. Kenneth Snyder, BSN, JD Editor/Publisher

In Hospital v. Bobinger, 2019 WL 3801664 (Tex. App., August 13, 2019), after the patient’s hip-replacement surgery the orthopedist obtained and he and a radiologist read an x-ray that appeared to show satisfactory alignment.  The patient was discharged after two days in the hospital.  However, at the time of discharge the patient could walk only with an unsteady gait, could tolerate little weight-bearing, had a lot of swelling in her hip and thigh and complained of pain during her physical therapy that was outside the normal range for postoperative sessions. 

Six days after discharge the patient had to be readmitted with a fracture of the proximal femur that required surgery. She came back to the hospital after two weeks and then after two more weeks had the hip replacement completely redone at another hospital.

The Court of Appeals of Texas accepted the expert opinion of an orthopedic surgeon that the patient’s nurses and physical therapist were partially to blame for her post-op complications. 

When a patient experiences an unexpected level of pain postoperatively the standard of care requires the nurses to report to the physician and advocate for the physician to hold off discharging the patient and reevaluate the patient to determine what is wrong.   The nurses’ failure to meet the standard of care can be seen as a basis for them to share liability with the physicians.

COURT OF APPEALS OF TEXAS August 13, 2019

When a patient experiences abnormal pain postoperatively it is a nursing responsibility to report it to the attending physician and advocate for the physician to reevaluate the plan for discharge pending further investigation.

Failure to carry out that responsibility could have been a factor in this patient’s complications later on.  The nurses did not need to wait until they knew what was causing the patient’s difficulties. They should have gone ahead and reported the obviously problematic signs and symptoms that pointed to a need for reevaluation. 


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