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Risk Management Issue In Pediatric Clinic

2458 words - 10 pages

Risk Management Issue in Pediatric Clinic
Introduction-Khushali
Unforeseen events will always be a risk that can accompany those receiving medical care. One way that these risks can be minimized is through the creation of a risk management team. Risk management teams serve to protect the interests of all parties involved in terms of patient services and privacy, costs, and most importantly, patient safety. They strive to control unsafe events from occurring by being proactive in care rather than being reactive to any given situation. This paper discusses the circumstances regarding T.G.’s care and the events that transpired before his untimely death.
FNP’s Option That May Have Changed ...view middle of the document...

The outcome of T.G.s case could have been different had the NP considered other options in providing his care. The NP could have made a list of differential diagnosis that could have helped them better narrow down the list of possible diagnoses. By including a list, they could have thought of other diagnostic exams that might have proved to be beneficial in his case. Also, a full review of systems should have been included in their write up and considered in their plan of care. It also seems that each time T.G. presented to the office, it was for an episode. He was never brought in for a follow-up visit.
In this particular (case or scenario) the cardiologist diagnosed T.G. with vasovagal syncope based on his history and physical. The pediatrician diagnosed a murmur and provided a list of differential diagnoses. The Cardiologist chose not to perform an EKG or do a long QT measurement. When reviewing syncopal algorithms one would have to question the cardiologists thought process of why these diagnostic components were missed when ruling out diffentials for T.G. Literature reviews suggest fainting is due to a sudden drop in heart rate and blood pressure.
Deficiencies of FNP SOAP Notes-Rose
Collaborative relationships not only are professionally satisfying, but also improve access to care and patient outcomes (Hanson & Carter, 2014, p.323). Deficiencies related to T.G.’s two soap notes written by the family nurse practitioner involved multi-factorial deficiencies in regards to: clinical consultation, co-management, the referral process, assertiveness, interpersonal competence, poor documentation of a detailed history and physical that played an integral part of T.G.’s outcome. When critiquing the first SOAP note written by the family nurse practitioner it lacks these basic components:
• Thorough history (e.g. prenatal, natal and post-natal, childhood illnesses, growth and development) and physical assessment-objective data, diagnostic studies done (e.g. tilt test, metabolic panel) in the office.
• Assessment/Plan-prevention and safety measures given to the child/family, non-pharmacologic/pharmacologic management; collaboration with the pediatrician to refer child to a pediatric cardiologist instead of basic cardiologist. Cardiologist did not work up the patient for a long QT measurement despite it being one of the differentials the pediatrician considered when T.G. was seen for the second time by the pediatrician and referred to cardiologist Dr. Farce. Discussion and/or collaboration with the pediatrician about a neurology referral since this was the third syncopal episode T.G. has encountered with a loss of consciousness. Plan of care and follow-up was inadequate.
• Clear and concise documentation- Documentation of clinical decision making with pediatrician about T.G.’s pattern of exercising and syncopal episodes that warrant further investigation by a pediatric neurologist/cardiologist.
• Differential diagnoses for T.G. - vertigo,...

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