Discussion on Delegation to Assistive Personnel

Week 2: Discussion on Delegation to Assistive Personnel

Initial Discussion scenario:

Nurse Case Study:
The CNA was at the home of a mutual patient and reported that her gastrointestinal (GI) tube had come out sometime during the night. The RN informed the CNA that the patient would need to go to the emergency department to have the tube re-inserted as it would be several hours before she could see the patient. The patient’s family didn’t want to take the patient to the emergency department but would instead wait for the RN to see the patient.

The CNA informed the RN that she had re-inserted several GI tubes when she was employed at a nursing home, so felt comfortable re-inserting this patient’s tube. The RN agreed to let the CNA insert the tube but advised her to not restart the feedings. Approximately 45 minutes later, the CNA contacted the RN and affirmed that tube was re-inserted without difficulty and proper placement was confirmed. 

When the nurse arrived at the patient’s home several hours later, she noticed that the patient was receiving tube feeding. When questioned, the daughter confirmed that she resumed the tube feedings shortly after the CNA left and denied being told to wait. The RN noted that the patient was complaining of abdominal pain and reported feeling nauseous.

On physical assessment, the patient’s abdomen was distended and positive for pain with abdominal palpation. After stopping the feeding, the nurse called 911 and the patient was transferred to the nearest hospital where she was diagnosed with peritonitis due to the GI tube being accidentally placed in the peritoneal space. The family filed a lawsuit against the RN and the home healthcare agency.

The allegations against the RN included:
· Wrongful delegation of patient care to unlicensed assistive personnel (e.g. CNA);
· Failure to follow the agency’s policies and procedures on proper delegation, GI tube insertion and supervision of unlicensed assistive personnel;
· Failure to contact the referring provider and obtain an order to reinsert the GI tube; and 
· Failure to assure that the patient and family had received appropriate communication related to re-inserting the GI tube and holding the GI feedings.

Resolution:

A settlement was reached prior to a lawsuit going to trial. As mandated by state law, the nurse was also reported to the National Practitioner Data Bank (NPDB).  The total incurred to defend and settle this case on behalf of our insured nurse exceeded $255,000.

Assignment:

1. Discuss what the nurse should have done to effectively control this situation and limit the risks of wrongful delegation? Give a detailed response and reference 2 evidenced based resources.
2. Identify 3 to 4 risk control recommendations that were learned from the required video that could have been utilized in this case.

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