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Short cutting nurses education can lead to hospital errors

A diagnosis is often not straightforward. The bodies response to sickness can be misleading. That is why good training for hospital staff is so important. Patient’s safety is directly related to investment in quality resources. Coordinated health records. Adequate staffing. And regular, quality training programs. An elderly man called Giovani was brought in to the hospital Emergency Department by his relatives. Giovani was very short of breath. The family told the doctor he’d had a cold for over a week. “The doctor gave Dad some antibiotic tables, but they didn’t work” said his daughter. The doctor examined Giovani. He was coughing up thick green sputum. When the doctor listened to Giovani’s chest with a stethoscope, course crackles could be heart. Doctors diagnosed a severe chest infection. He prescribed Giovani intravenous antibiotics and told him he would be admitted to hospital for a couple of days. The family was relieved. At least Giovani was getting some attention. Nurses tried to find his medical history. But Giovani spoke very little english and his family didn’t know much about his health. They just wanted him kept comfortable. “Did he smoke?” The family didn’t know. The nurses did Giovani’s observations and were concerned that his oxygen levels were quite low. Giovani was struggling to breath and kept coughing up sputum. Nurses wanted to get his oxygen up to ‘normal’ levels, so they gave him oxygen via a mask. He was also given inhalers to open his airways, and saline nebs. With the oxygen and medications, his shortness of breath seemed to subside. Giovani appeared more comfortable and less restless. No previous medical record could be found for Giovani. Apparently he normally lived in another city and had just come down to see his grandchildren. A specimen of sputum sent off for testing, to see what type of chest infection he had. His family stayed to make sure he was comfortable, then went home. A bed was found for Giovani on a general medical ward. Nursing staff were used to dealing with a range of elderly patients. They had general medical diseases like dementia and infections. The ward nurse who admitted Giovani checked his oxygen levels. They were still low. She turned up the oxygen mask from 6 litres to 8 litres a minute. He got undressed and got into bed. By now Giovani was slow moving and a little confused. The nurse made sure he got his antibiotics on time and checked to see that the sputum specimen had been sent off to pathology. Nursing staff were busy overnight, and only checked Giovani intermittently. He slept soundly. At 6 am the night staff had difficultly raising him. She thought that was odd. It was a large open ward, the lights were turned on as nurses did obs and gave medications. Most patients were awake by that time. She checked to see that his oxygen was still on. His oxygen levels were coming within low to normal range. So she turned the oxygen up to 10 litres. As usual the early morning shift was rushed. Patients had to be given tablets, taken to the toilet, cleaned up and fed. By 9am the doctors were starting their round. Giovani was found lying in bed, with the oxygen mask on at 10 litres, unconscious. A code blue, or emergency call was made. The crash team, or resuscitation team rushed in. A junior doctor did an arterial blood gas. It showed that Giovani had type 2 respiratory failure. Giovani was taken by ambulance to a more advanced hospital, with an Intensive Care Unit. He subsequently died. Nurses in this hospital all worked short shifts, seven and a half hours, instead of the normal eight hours. This saved the hospital from paying for an extra half an hour per nurse, per shift. The hospital management though this was economical. However it also meant  there was no time available for any nursing education to take place. As a consequence, nurses did not revise essential knowledge, like the difference between type 1 and type 2 respiratory disease. Their was no in house education at all. It was just left to nurses to ‘manage their own education’. © Wikihospitals 2014

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