Accountability in Nursing Practice: Case Study and Analysis

Running page: Nursing 1
Professional Accountability
Student’s Name
Professor
Course
Date
HEALTH CARE COMPLAINANT V TRIPODIS [2018] NSWCATOD 12

Nursing 2
Introduction
Accountability in nursing practice remains an important aspect of medical decision-
making that has upper hand in preventing adverse clinical outcome. Ethical standards of practice
play a critical role in ensuring that patients are offered appropriate care with a high level of
accountability hence prevent escalating adverse medical condition. Actions or omission to a
specific aspect of care may result in the patient's deteriorating health leading to death. Such
actions attract tribunal case leading to suspension or cancellation of registered nurse registration
or imprisonment. There are many different cases before the tribunal that are under hearing
pending determination and all cases are due to adverse event. One example of the case involved
patient identified as Patient A and nursing practitioner that led to the suspension of the
practitioner's registration. The following paper explores one case that involved registered nursing
practitioners that lead to the death of the patient.
Case synopsis/overview
The adverse medical outcome occurred between the patient and a registered nursing
practitioner. The patient identified as Patient A of age 61 years and was diagnosed with tracheal
cancer and undergone laryngectomy on 4 December 2014 at Prince of Wale Hospital and
subsequently required tracheostomy tube. Patient A was in Medical Subacute Unit (MSU) at the
Prison Complex but prior to his death, he was admitted to Prince of Wales Hospital. Patient A
had difficulty in breathing, stoma obstruction and cellulitis as result, Patient A died at the facility
due to the practitioner's observe patient and provide him necessary care. The registered nurse
involved in the case was Tripodis and received a registration suspension of 6 months pending
completion of a course in ethics of professional practice and practice under the supervision of a

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registered nurse (Division 1) (Civil and Administrative Tribunal New South Wales
(NSWCATOD) 2018).
Actions/Omission Contributed to Adverse Outcome
Actions
There are some actions of the practitioners that contributed to the adverse medical
outcome of Patient A. Tripodis gave Patent A nebulizers to use at night when she was on night
shift. The registered nurse administered the nebulized saline to the patient but only noted the
medication without the reason for administering the medication to the patient. According to the
prescription of PRN, giving the patient any medication needs proper documentation which was
not the case. In addition, the practitioners also administered diazepam as a regular medication to
Patient A. According to the case, the practitioner recorded limited information on the medication
given to the patient contrary to the normal procedure of patient health records (Kalisch & Boqin
2014). Another action of the practitioner that was no consistent with the standard of practice was
advising the patient to knock up whenever he needed assistance from nursing practitioner. This
was not appropriate given the speech impairment of the patient that could not allow the patient to
communicate with anyone. The practitioner visited patient late than necessary since the
practitioner was supposed to attend to Patient A 12:00 am and 4:00 am but instead attended to
the patient at 6:30 am after being notified by the Corrective Service Officer. This was a
substandard practice expected of a registered nursing practitioner especially on night shift
(Halpern et al., 2011).
Omission

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The registered nurse did not perform various visual observations to the patient at the time
when the patient was vulnerable. The registered nurse Tripodis between 5th February 2015 at
8.40pm to 6:35 pm of 6 February 2015 failed to provide the required care to Patient A and also
failed to perform a full set of observation such as monitoring temperature, blood pressure,
respiration, and oxygen. Therefore, in two hours the practitioner did not perform a visual
observation that included the assessment of the breathing and airway status through the
practitioner decline to accept these allegations (Moumtzoglou 2010). In addition, the
practitioners advised the patient to knock up in case he needed assistance during the night shift.
This was not appropriate since the patient was not capable of communicating due to speech
impairment. Between 12:00 am and 4:00 am, 6th February 2015 the registered nurse did not
supervise or confirm Patient A self-administration of nebulized saline since the nurse could have
seen that patient A needed assistance. This implies that the practitioner failed on that day 6th of
February 2015 to record the patient's clinical notes and medication that included reasons for
administering nebulized saline between 12:00am to 4:00am. The practitioner also did not record
the reason for administering 10mg of diazepam at 8:00pm. The registered nurse, therefore, did
not comply with the requirement of the NSW policy of recognition and management of patients
who are clinically deteriorating (NSWCATOD 2018).
Factors that contributed to the adverse clinical outcome
There are many different factors that contributed to a patient's adverse medical situation
leading to the suspension of the nurse registration. The practitioner worked within the prison
where patients are aggressive and the environment needs more care for practitioners. The
practitioner indicated that the patient was known to be aggressive and difficult to work with. The
prison culture is characterized by aggressiveness and Patient A particularly was known for being