Put a stop to dangerous practices for ED transports
Put a stop to dangerous practices for ED transports
An ED patient with an intravenous line with heparin medication being administered by pump was brought for an X-ray, but not by an ED nurse. The unlicensed assistive personnel (UAP) transporting the patient inadvertently opened the pump to remove the patient's gown.
"This allowed free flow of the medication rapidly into the patient, causing the patient's overdose and eventual death," says Christine Macaulay, RN, MSN, CEN, who reviewed the case as a legal nurse consultant. "The case was settled out of court." Macaulay is nursing practice and safety specialist at The Children's Hospital of Philadelphia.
Even if you delegate transport to another individual, you as the ED nurse remain legally responsible for the patient's outcome, warns Macaulay. "Know the competency of the person you are delegating the task to, as well as the scope of the role the UAP is hired into, according to state and health system regulations," she says.
In the above case, the UAP was not instructed on safety precautions required when transporting patients with a medication infusing by pump. The ED nurse did not use appropriate delegation measures and lacked knowledge of the UAP's competency, says Macaulay.
Too often, transport of ED patients is done by unlicensed staff who lack the qualifications or experience to safely monitor the patient, says Macaulay. "I have reviewed legal cases where the ED nurse demonstrated a knowledge gap in the practices needed to safely transport patients," she says. "In some situations, unlicensed staff may perform tasks outside of their scope of practice, without knowing the safety risk for the patient."
A March 2009 report from the Pennsylvania Patient Safety Advisory found that serious patient incidents were identified in 10% of 2,390 in-hospital patient transport reports. These included transporters making adjustments to equipment outside of their scope of practice and disconnection of pumps, lines, and tubes.
The report recommends doing a "pre-transport patient assessment" to determine your patient's stability and the level of monitoring needed during transport. "Even something as simple as providing appropriate transport equipment can be critical in preventing poor outcomes," says Macaulay. "However, this can be challenging in the real world of the ED. An all-too-common question in today's EDs is, 'Where is a wheelchair or stretcher?'"
Although critically ill patients are stabilized prior to transport anywhere, there always is the chance that the patient could become unstable during movement from one place to another, says Jessica Symank, RN, assistant nurse manager of the ED at Virginia Mason Medical Center in Seattle. "Our ED nurses accompany these patients wherever they go. We place the patient on a portable monitor and defibrillator, if needed, during transport," says Symank. "This allows us to continuously monitor the patient's vital signs."
The ED nurse also does a continuous assessment of the patient during this period. "We also carry emergency equipment, such as airway supplies and emergency medications," says Symank. "If the patient is ventilated, a respiratory therapist accompanies the patient and nurse to and from testing, and remains with them during the procedure."
An ED patient with an intravenous line with heparin medication being administered by pump was brought for an X-ray, but not by an ED nurse. The unlicensed assistive personnel (UAP) transporting the patient inadvertently opened the pump to remove the patient's gown.Subscribe Now for Access
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