Legal Update: Are You Ready for an Emergency?

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Legal nurse consultant: Prepare for a crisis before you have one.


The 18-month-old in the recovery room wasn’t my case, but then his care took a sudden turn. When the toddler became hypoxic, the anesthesiologist looked at me and yelled for my help because of my background. I’m a CPR instructor. I’m trained to offer advanced life support to pediatric and adult patients. The anesthesiologist knew I could help when he really needed me. And so, we went to work.

We were able to save that 18-month-old toddler who needed CPR, and we took great relief that he made it through. I didn’t think I’d need to perform CPR that day, but I was prepared. I had the training. We’d practiced the emergency drills and made sure our code carts were properly checked and stocked for such an emergency.

When it was all over, we looked at how we handled the situation. There were a few things we could have handled differently, and we learned from it. Take it from a legal nurse consultant. Every surgical facility needs to prepare for an emergency. As a surgical facility leader, you should ask yourself if you’d be ready in a similar circumstance. If you’re not, you’re leaving yourself wide open to a lawsuit. More importantly, you’re putting your patients at risk.

Concerning trend

Some facilities are making the news for all the wrong reasons. Across the nation, we’re reading about when surgery goes wrong. Some of the mistakes are downright careless, such as empty oxygen tanks and expired medications on the code cart. When patients need us to be at our best, we can’t fall short or get in our own way.

I’m not just a recovery room nurse and a nurse educator, but I also work as a legal nurse consultant. It’s my job to evaluate how well facilities and their staff handle themselves in a crisis. In a lawsuit, your culpability hinges on your ability to follow the standards of care. Here are some of the basics you need to consider:

CART SMARTS Regularly check the inventory in your code cart for expired medications and supplies you need to be replenish.

1What’s your plan? Long before you have an emergency, you should craft an emergency plan and go over the essential roles.

All the members of the staff, from the assistants at the front desk to the clinicians in the OR, need to know their role. During an emergency, you should know who will meet the ambulance crews and who will do CPR. You need a point person to organize the staff and to document medications and event times. Having defined roles decreases confusion in a crisis.

Emergency plans are not one-size-fits-all. A hospital outpatient surgery center adjacent to an ER will have a much different emergency plan than a freestanding ambulatory surgery center. If you perform pediatric cases, you’ll need to develop specific guidelines to that patient population, as well.

2Code cart and supplies. How often are you taking inventory of your code cart? Every facility should have fully stocked crash carts with all of the drugs and equipment recommended by the American Heart Association. You also should have a dedicated malignant hyperthermia plan.

Imagine reaching into your crash cart for the one drug you need to revive a patient and discovering it’s on back order. It’s an easy mistake to make, and it’s easily preventable. Do a monthly inventory check and make sure all your drugs and supplies are available and up to date. That’s also true of your automated external defibrillator. Keep track of the pads and battery on your AED, and you’ll be ready for a patient who goes into sudden cardiac arrest.

3Practice makes perfect. It’s one thing to have policies. It’s another to be ready for an emergency. Mock drills help your staff understand the different roles they’ll need to assume in a crisis.

Every few months or so, you should run through an emergency drill from beginning to end. Your patient has a severe allergic reaction. What do you do? Who’s managing the code cart? What drugs do you need, and when do you call 911? Everyone should be flexible enough to step into a different role. Your staff should be trained and certified in basic and advanced levels of life support, so they’re ready at a moment’s notice.

4Discharge criteria. Treat ‘em and street ‘em? Don’t do it. You should never be in a rush to get patients home. Your providers need to follow your facility’s rules and patients must meet discharge criteria before you discharge them. A hasty discharge can have fatal consequences. We’ve seen several cases where patients died on the car ride home. Don’t make the mistake and think a seemingly stable patient is OK to send home if the patient hasn’t met all of your discharge criteria — stable mental state, can ambulate, pain is controlled, can tolerate food and drink, able to void, for example — and has a friend or family member to drive her home.

5Learning experiences. Emergencies put your preparation and policies to the test. Debriefing after an emergency is always a good learning experience. Did you follow ACLS protocols? Did someone record in your CPR code sheet who intubated the patient, and when the first medication and CPR began? Was someone available to give the appropriate medications?

All the right moves

We know preparation has its limits. Sometimes, we can do all the right things and still have a bad outcome. We also know we can do everything wrong and get lucky when a patient somehow pulls through. When it comes to emergency preparedness, you should take a hard look at your staff and ask a simple question. Everyone who comes in contact with the patient should be able to answer with confidence: “Are we ready?” OSM

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