Code: Intubation Supplies Not Available In ICU.

Code: Intubation Supplies Not Available In ICU.

Legal Eagle Eye Newsletter for the Nursing Profession

June 2014

The standard of care requires a hospital to have intubation equipment and supplies immediately available in the ICU and ER, including a laryngoscope with blades of various sizes, endotracheal tubes of various sizes, laryngeal mask airways and naso- and oropharyngeal airways. COURT OF APPEALS OF TEXAS May 8, 2014

The adult patient came to the hospital with difficulty breathing, dizziness, nausea, vomiting and pain in his throat and ear. He appeared depressed and had difficulty with verbal communication.

He was taken to the ICU. IV fluids, insulin and medications to address his agitation and restlessness were ordered. He became increasingly agitated and unresponsive to verbal stimuli.

At 2:25 a.m. his heart rate and O₂sat dropped suddenly. He was put on 100% O₂by mask. Five minutes later his heart rate dropped to 39. A code was called. Chest compressions were started and he was ventilated with an ambu bag.

The patient was not intubated for almost forty-five minutes, by which time there was extensive permanent brain damage. The problem was that intubation supplies were not in the ICU room and were not brought to the room right away.

The Court of Appeals of Texas ruled the patient’s family’s expert correctly stated the applicable standard of care.

Being able to start rapid sequence intubation is a cornerstone of emergency airway management, the Court said.

The standard of care mandates that a hospital must have essential equipment and supplies immediately available in the ICU and ER and stocked on the crash cart to be brought to patient rooms. Hospital v. Washington, 2014 WL 1882763 (Tex. App., May 8, 2014).