“This week’s topic is Risk Management: “Reactive vs Proactive” Directions: Week

“This week’s topic is Risk Management: “Reactive vs Proactive”
Directions: Week Six identifies three cases where a patient’s rights were not upheld. After reviewing the cases, use the Rosemary Flanigan case, “Could this happen at our hospital” to discuss whether or not a Risk Management reactive (fixing) or proactive (preventing) approach is best.
1.Briefly explain the concept of Risk Management and how/when it originated. What is its purpose?
2.How could Risk Management assure Nurses might “fix” in-the-moment problems in the case?
3.How could Risk Management assure Nurses might “prevent” the sequence of problems in the case?
Case study below. A 79-year old white female with advanced ovarian
cancer, severe back and abdominal pain, COPD,
depression and anxiety disorder, and asthma was
admitted to the hospital from Happy Valley Nursing
Home through the emergency room. She had had
difficulty breathing and the ambulance was called. All
the records of her case history accompanied her.
The ER staff intubated her and after a short time, she
was weaned from the respirator and sent to the medical floor. It was agreed that she was
unable to withstand surgery, but she still was suffering from back and abdominal pain. She
could breathe on her own, so she was sent back to the nursing home after being put on Xanax
and Neurontin.
Within 24 hours she was returned to the hospital in abdominal and back pain, nausea, and
emesis. She received some relief from Darvocet and Dilaudid (q8h). The oncologist was called;
the patient was made comfortable within a few hours.
From her first admission, her family requested comfort care only; a DNR was signed. The
patient’s status continues to decline, the prognosis is grave, the patient is dying, her respirations
shallow, and the attending physician discontinues morphine.
The patient becomes unresponsive. At this point the family panics and rescinds the DNR. The
patient is intubated and sent to ICU. There is no indication on the chart that anyone recognizes
the patient is in the dying process.
What physicians saw the patient? Cardiologist, pulmonologist, dermatologist, oncologist,
onc/surgeon, thoracic surgeon, 3 psychiatrists, neurologist, neurosurgeon, anesthesiologist,
infectious disease specialist, GI specialist, hospitalist.
What was she given? Massive diarrhea, rashes and excoriations, decubiti, generalized edema,
c-diff… pseudomembranous colitis, ventilator dependency, Nubain for pain.
On day 51 of her hospital stay, her family signed a DNR again. She died the next day in ICU.