Patient Case Study

The case study (HCCC v Jarrett, NSWNMPSC, 2013) explains the enquiry made into the role and activities of registered nurse [RN] Janelle Jarrett in respect to the care of a patient during a night shift from 30th September 2011 to 1st October 2011. RN Jarrett was rostered as the Hospital in Charge [HIC] and Nurse in Charge [NIC] of a general ward. The patient first presented to Ballina District Hospital emergency department [ED] at 1428 hours on 30th September 2011 with increasing shortness of breath [SOB], muscular aches and pains and a history of chronic obstructive pulmonary disease [COPD]. The patient was triaged as category three and investigations into medical records detailed documentation that described the patient’s SOB as being secondary
From 2300 to 0200 the patient was observed to be combative and restless with increased work of breath, however these observations were not reported to Dr McKenzie the General Practitioner Visiting Medical Officer, nor were thorough nursing assessments performed. At 0200 RN Jarrett phoned Dr McKenzie requesting a sedative for the patient, failing to convey an adequate account of their physical and mental condition. At 0225 hours the patient experienced an unwitnessed fall following the administration of 5mg Valium. Subsequently, neurological observations were commenced and repeated at 0340 with a Glasgow Coma Scale [GCS] of 6/15. Dr McKenzie arrived at the hospital between 0630 and 0700 hours, and was then informed of the patient’s unwitnessed fall, GCS score and condition. The patient was then transferred to Lismore Base Hospital [LBH] at 0930, presenting with confusion, increased SOB, decreased LOC, abnormal vital signs and a GCS of 3/15. The patient continued to deteriorate and was palliated, passing away at approximately 1900 hours on 1st October, 2011. 318
(2014, p.259) Explains that poor communication and handover contribute to adverse outcomes for the patient. This is epitomised in the poor inter-professional communication skills of RN Jarrett, where her failure to speak up and clearly deliver an accurate handover of the patient’s deteriorating condition in order to promptly escalate care (Garon, 2011, p.361) and failure to notify the doctor of the subsequent fall and GCS of 6 until he arrived in the morning (HCCC v Jarret, 2013, 49-50, 68) could have contributed to the patients adverse outcomes. Furthermore, RN Jarrett and the other nurses did not demonstrate adequate written communication skills, shown by the lack of documentation and records of tasks, events, observations, vital signs and GCS scores obtained during the shift. Inadequate records make it extremely difficult for health care professionals to recognise the deteriorating patient, and poor communication contributes to a failure in the application of adequate skills and knowledge to care for the deteriorating patient (Tower & Chaboyer, 2013, p.1406; HCCC v Jarret, 2013,