Case Study 1

Logan, a 41-year-old patient with a history of hypertension, is seen in the Cardiology Clinic for a follow-up after his recent admission to rule out myocardial infarction. His vital signs are normal except for a BP of 180/120. An EKG shows NSR without evidence of ischemic changes. He states that he has been having episodic chest pain since his release, so the physician decides to repeat his cardiac enzymes. His CPK is 201, and a Troponin I level is pending.

Mr. Logan's pain resolves, and he insists on going home. The Troponin I level is still pending when Mr. Logan is discharged with instructions to call the office the next day if he is still having problems. Shortly after Mr. Logan is discharged, the Troponin I level of 0.23 (normal <0.03), indicating myocardial ischemia, is called into the nurse in the clinic. The nurse notifies the physician of the result. No attempt is made to contact Mr. Logan. Later, he is found unresponsive and having difficulty breathing. His friend calls 911, and when the ambulance crew arrives, they find him apneic and they cannot detect a pulse.

Case Study 2

It is ordered that Mr. Henry, a patient admitted for an upper GI bleed, is to receive a unit of blood run over 4 hours. Nurse M, who is caring for Mr. Henry, is anxious to get started hanging the unit of blood since it was delivered to the unit 20 minutes earlier. Hospital protocol requires two nurses to verify that the correct patient is receiving the correct blood product and type before hanging the unit. At this time, however, another patient in the unit is being resuscitated, and staff availability is limited. Nurse M decides to hang the blood without double-checking. Shortly after the blood is hung, the patient spikes a temperature and experiences shaking chills. Nurse M has inadvertently hung blood for another patient named Henry.

1.In both scenarios, the nurse and physician failed to advocate for the patient. Could you please identify the errors that occur in these two case studies?