Electronic Patient Monitor Turned Off: Nurses Guilty Of Negligence
Legal Eagle Eye Newsletter for the Nursing Profession
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Quick Summary: It was not up to the nurses’ discretion to activate the monitor only when the patient was sleeping or unattended. Even so, the patient was in bed for twenty minutes before he was found in distress.
A healthcare facility is liable for the negligence of a nurse if the nurse violates the legal standards of negligence applicable to nurses. The facility’s liability is assessed in light of the nurse’s actions.
A nurse is expected to possess and exercise the degree of professional skill ordinarily possessed and exercised by other members of the profession in similar circumstances. That meant in this case the nurses were obligated to follow the in-house physician’s orders and care plan. The monitor was to be turned on at all times twenty-four hours a day.
Admittedly the nurses were annoyed because the alarms would sound for no apparent reason, and the young patient at times would hold his breath just to get the nurses’ attention.
But that is not a defense to liability. COURT OF APPEAL OF LOUISIANA, 1999.
The patient was diagnosed with hyaline membrane disorder shortly after he was prematurely delivered by his sixteen year-old mother. He stayed in the premature nursery several months and then was placed in foster care after his mother gave him up for adoption. He was admitted to a state-run developmental center at age four. Following an episode of respiratory distress at age thirteen he was hospitalized for a tracheostomy.
When he was discharged back to the developmental center the hospital physician ordered a monitor for when he was unattended or sleeping.
The developmental center’s own in-house physician, however, ordered continuous twenty-four hour monitoring.
The monitor was supposed to be set for 15 seconds apnea, bradycardia of 50 and tachycardia of 150, according to the Court of Appeal of Louisiana. Actually, according to the court, the monitor was set for 12 respirations per minute, bradycardia of 60 and tachycardia of 132. The monitor was constantly sounding, so the nurses often turned the monitor off.
There was an apnea monitor chart to be completed by the nurses to insure the monitor was being kept on, but it was not followed on a consistent basis.
In addition, the care plan mandated the patient when in bed was to be alternated from his left to his right side to facilitate breathing and he was never to be allowed to lie on his back or his stomach.
The patient was found with his trache out of the stoma. He was lying on his back. Efforts were made to replace the trache and to do CPR, but he arrived at the hospital dead and was pronounced forty-two minutes after he was found.
The adoptive parents sued the state for the nurses’ negligence. The court upheld the suit. The only logical interpretation of the evidence, the court felt, was that the monitor had been turned off, which caused the child’s death. Odom v. State of Louisiana, 733 So. 2d 91 (La. App., 1999).