Failure to document
Louis is much happier attending his present school. His community health Registered Nurses [RNs] agree that visiting Louis at school to give him medications is definitely a bright spot in their day. Louis has numerous health problems, all stemming from cerebral palsy. He has a J tube for feeding and medications, and a central venous line [CVL] for total parenteral nutrition. The community health RNs who attend to him at his school were pleased to observe that his new school, its teachers and students, all seem to have had a positive effect on his health. He has been experiencing fewer infections lately.
Due to staff shortages, certain tasks have been delegated to Licensed Practical Nurses [LPN] by the employer. As such, Stevie, an LPN at the facility, will now be caring for Louis. Stevie quickly adapted to caring for Louis. She learned the rhythm of his speech and was able to converse easily with him within a few days. She spent as much time as she could chatting with him about his schoolwork.
One day, Stevie noticed blood in Louis’ J tube as she was inserting his medication. Nothing untoward seemed to happen, so she did her usual charting and left to attend her other patients. The next day, Stevie arrived at Louis’ school only to discover that they had forgotten to inform her office that Louis was not well and had stayed home from school that day. When Stevie returned to the office at the end of the day, she discovered that he had been hospitalized that morning.
A week later, Stevie received terrible news. Louis had been critically ill with a systemic infection that was attributed to contamination of his CVL. The type of bacteria found led Louis’ doctors, and Stevie’s boss, to suspect that the CVL was used without sterile technique. Specifically, her boss thought that she administered a medication through the CVL rather than the J tube.
Stevie and her boss looked through Louis’ chart and saw that there were only two notations relating to his CVL in many weeks’ worth of charting done by the RNs. Stevie had not known that Louis had two lines and neither had her employer when they assigned Stevie to provide care for Louis. Stevie had no knowledge or experience with CVLs but she is now aware of the significance of the blood she saw in the tubing the last time she saw Louis.
Eventually, Louis recovered and was able to return to school. He still receives care from community health nurses, but he and his family felt so strongly that such an incident should never happen again that they commenced a civil action against two RNs, Stevie, and their employer for negligence. The employer is paying for a lawyer to defend the two RNs and Stevie.
 Names, characters and locations in this article are fictitious. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.
The following links to infoLAWs will help you to answer the quiz: Delegation to Other Health Care Workers, Quality Documentation, The Nurse as a Witness, Legal Risks in Nursing, Malpractice Lawsuits, Confidentiality.