48 hours- case study

Case Study #2:  Disagreement among surrogate decision-makers and with advance directive

A 72-year old woman who was admitted to the Neurological Intensive care unit following a cerebral hemorrhage which left her with severe brain damage and ventilator dependent. One year before this event, the patient and her husband had drawn up “living wills” with an attorney. She was diagnosed by her attending physician as being in a permanent unconscious condition. The patient’s living will specified that the patient did not want ventilator support or other artificial life support in the event of a permanent unconscious condition or terminal condition.

The patient’s husband is her legal next of kin and the person with surrogate decision-making authority. When the living will was discussed with him, he insisted that the patient had not intended for the document to be used in a situation like the present one.  Further discussion with him revealed that he understood that the patient would not be able to recover any meaningful brain function but he argued that the living will did not apply because her condition was not imminently terminal. He further indicated that he did not consider his wife to be in a permanent unconscious condition. The immediate family members [the couple’s adult children] disagreed with their father’s refusal to withdraw life support.

The treatment team allowed a week to pass to allow the husband more time to be supported in his grief and to appreciate the gravity of his wife’s condition. Nevertheless, at the end of the time, the husband was unwilling to authorize withdrawal of life support measures consistent with the patient’s wishes as expressed in her living will.

Questions

Defend/discuss your answers to the following questions WITH appropriate current peer-reviewed research.

1. What are all of the ethical and the legal parameters [there are, at minimum, 3-4 issues] involved here and why? (Name and number each issue)

2. Understanding that there are both ethical and legal implications involving this case, as the Health Care manager of this facility, what should be done in this case and/or how would you “manage” this situation?

3. What is your action plan to “manage” this situation? BE DETAILED

4. Who are the stakeholders (Persons involved) in this case? Why?

PAPER FORMAT IS HIGHLIGHTED IN YELLOW. FILL IN EACH SECTION, PROVIDE RESEARCH, NOT JUST OPINION WITH IN-TEXT CITATIONREFERE

Case Summary

Introduction

1. What are all of the ethical and the legal parameters [there are, at minimum, 3-4 issues] involved here and why? (Name and number each issue)

1. Understanding that there are both ethical and legal implications involving this case, as the Health Care manager of this facility, what should be done in this case and/or how would you “manage” this situation?

1. What is your action plan to “manage” this situation? BE DETAILED

THIS IS AN EXAMPLE OF AN ACTION PLAN HIGHLTED IN TEAL

Risk Management Action Plan EXAMPLE

Risk management is an integral aspect for healthcare professionals as far as their practice is concerned. This case is therefore not an exception. The risk management plan in this case will include the identification as well as evaluation of the risks that are involved in the case and thereafter, the enumeration of ways through which the same can be mitigated (C., McGuigan, Verbrugge, & Epstein, 2005).

• What is the main issue: In this case thre seems to be two main issue the first is the lack of clarification given by the pharmacist to the nursing facility and also the nursing facility lack of protocol for administering such potentially toxic drugs such as morphine.

• What action will occur: Pharmacist communication training, posting up communication guides that will assure all points are covered when explaining medication dosage to any person, nursing facility medication dosage training, and hanging reminder bulletin with important dosage and times between dosage. Finally reminders during employee meetings for both pharmacist and nursing facility employees.

• Who will carryout and what resources will be used: Both issues are independent of each other. Therefore, the nursing facility as well as the pharmacist both need the appropriate training to assure that they are following protocol and communicating effectively with every and anyone, especially in regard to medication dosage. The manager can set up courses that can teach the pharmacist how to explain medication dosage to all medical professional while still disregarding their medical proficiency. It is important to not assume that simply because someone works in the medical profession, they are aware of when morphine dosages should be administered or how often. In the case of the pharmacist, their specific facility manager will be in charge of setting up these trainings. As for the nursing facility, human resources will bring other medical professionals that can teach their employees about appropriate medication dosage, when to question a dosage and what protocol to follow in the event that a dosage may be of the wrong amount. Also establishing that, questioning things such as this is for the best, in order to prevent malpractice suits as in the case of the plaintiff.

• By when will it take place and how long for: The deadline will be one month after the first meeting that will establish what changes will be occurring and how they will occur. These trainings should occur on a quarterly basis for all old employees, and as a part of new employee training upon hire. For the nursing facility, it should be made mandatory and a medication dosage course or certification be taken every 6 months to assure that employees are staying up to date with new standards for dosing. In the case of a pharmacist lack of communication, this should be a weekly reminder to all employees in the pharmacy, especially pharmacist. This process should continue for a period of one year and then reassess if there are changes that need to be made in order to make it better, based off employee performance and facility performance.

• Communication: For the health practitioners; Health practitioners should not only comprehend, but also maintain the standard of care that can be applied to the relevant setting (Reason & Carthey, 2011). It therefore follows that the practitioners inherently need to understand the clinical symptoms of the patient and the ways through which the same can be managed. It should also be a prerequisite to ensure that the patient’s medical as well as their family history is obtained, reviewed and documented (Reason & Carthey, 2011). Any medication concerns should be discussed with the consulting pharmacist. In addition, for the nursing facility; Identify as well as address any potential concerns or questions related to the treatment orders that have been provided by other practitioners before accepting the responsibility of care for the patient. With close reference to the evaluation of risks, it will also be vital to include the documentation of all the patient-related discussions in the risk management plan (Cagliano, Grimaldi, & Rafele, 2011). The intuition in this case is that this provides the best legal defense, that is, the complete health information of the patient.

1. Who are the stakeholders (Persons involved) in this case? Why?

CONCLUSION

REFERENCE PAGE

Rubric for Case Study 2: Disagreement among surrogate decision makers

This assignment involves your having to do research. You cannot rely on your textbook.  Also if you list a reference there should be an in-text citation, and YES I do check references.  Finally, be sure to RESTATE each question. Good Luck and Happy Researching!