Transition to Professional Practice

Transition to Professional Practice
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Patient Safety: Part A
Stanley Valentine Whiley, also known as Mr. Whiley passed away on March 6th, 2010 at Launceston General Hospital. It has been Dr. Lee Jones’ long-standing practice to attend Tamar Park every week to treat its residents on an as-required basis. He conducted an assessment of Valentine Whiley on June 18th, 2009 and it was reported that the medical history of Mr. Whiley consisted of decreased mobility, rheumatoid arthritis, depression, as well as cognitive impairment. Mr. Whiley was transferred to Tamar Park because he was not able to perform self-management and self-care, and he needed assistance in everyday activity.
Even though it was deteriorating, the medical condition of Mr. Whiley remained moderately stable until February 2010. Nonetheless, he experienced seizures on February 16th 2010 and was rushed to Launceston General Hospital, and was diagnosed as having suffered stroke and a cerebral infarct. On February 26th 2010, he was taken back to Tamar Park, but his medical condition continued to decline. Sederer (2013) pointed that patients not only have a right to treatment, but they also have a right to decline treatment. At Tamar Park, it was noted that Mr. Whiley refused medical care, drugs, liquids and food. It was particularly recorded that he refused drugs on March 4th, 3rd and 2nd 2010. A patient has the right to decline treatment, procedure or medication provided by the healthcare facility to the extent that is lawfully permissible. In such a case, the doctor will have to tell the patient the medical end-results of the patient’s refusal of procedure, treatment or medications (Geisinger, 2014).
With regard to the circumstances that resulted in the death of Mr. Whiley, at around 12:45 pm on March 6th 2010, Mr. Perry administered to him a 5mg dosage of morphine sulphate for pain relief as he looked in pain and distressed. Mr. Whiley was being managed as a palliative patient and subcutaneous morphine was to be administered to him after every 4 hours for pain relief. During the pre-dinner medication rounds done by Ms. Lord, Mr. Whiley refused to open his mouth to take a tablet as his oral dosage of predisolone. From around 4:00 pm onwards, Mr. Lord was reminded severally by the extended care assistants that the next dose of Mr. Whiley comprising morphine sulphate was late. Ms. Lord was not familiar with the standard dose of morphine. She actually made an error in her calculation of the dosage.
Beauchamp and Childress (2009) noted that it is of great importance for a medical professional to verify the medication that he/she administers to a patient in order to avoid any negligence and/or malpractice such as an overdose, administering the wrong medication or administering the correct drug incorrectly. The dosage was administered by Ms. Lord to Mr. Whiley at 5:00 pm. The 25mg dosage of morphine sulphate administered to Mr. Whiley was actually an overdose. When Ms. Lord went to administer the next morphine sulphate dosage to Mr. Whiley, she found him dead.
To determine the actual cause of death, Dr. Christopher Lawrence, the State Forensic Pathologist conducted a post-mortem examination on the deceased Mr. Whiley and established his cause of death was the combined effect of morphine intoxication, left cerebral infarct and ischaemic heart disease. According to Dr. Lawrence, prior to the administration of the morphine overdose, Mr. Whiley was perhaps suffering from aspiration pneumonia and his death was imminent. If this was how it really transpired, then it could be reasonably accepted that the aspiration pneumonia was the result of left cerebral infarction and/or ischaemic heart disease. Secondly, Dr. Lawrence noted that the cerebral infarction and/or the ischaemic heart disease were likely to have contributed to the death, and there was a possibility that the morphine did not contribute to the death. Thirdly, Dr. Lawrence noted that the closer the death of Mr. Whiley occurred to the administration of the morphine, then the more it was likely to be the cause. Lastly, Dr. Lawrence stated that the morphine overdose might have been the straw, which in fact broke the back of the camel.
Dr. Ross Ulman provided a causal relationship between the morphine overdose and the death of Mr. Whiley. According to him, the morphine overdose was not a certain cause of the death of Mr. Whiley, and that the causative factor was more likely to be the combined effect of the left cerebral infarct and the ischaemic heart disease. Each of these was individually more likely to be the cause compared to the overdose of morphine. Dr. Ulman maintained that the morphine overdose was not out of question; it might have caused but there was no certainty. As such, it was concluded that although the morphine overdose was a likely cause, there was clear evidence from Dr. Ulman and Dr. Lawrence that the left cerebral infarct and the ischaemic heart that Mr. Whiley had were causative factors and both were more certain to have caused the death than overdose of morphine. While people can make errors and mistakes, it is possible that an error is a consequence of the complexity of the system wherein it happened (McDonald & The, 2014). It is of note that before Mr. Whiley was given the drug overdose, his life expectancy was in fact measurable not in days, but in hours.
Patient Safety: Part B
The coroner established that the cause of death of Mr. Whiley was the combined effect of left cerebral infarct and ischaemic heart disease, and that nobody actually contributed to cause of death. However, if the findings had been different and the coroner established that Mr. Whiley inconclusively died as a result of the morphine overdose, then it is possible that criminal proceeding could occur against some of the personnel who were involved, particularly against Ms. Lord.
The tort of negligence would then be applied. It is of note that in the course of nursing practice, nurses may cause death or serious bodily harm to their patients. Such events provide facts that may be the subject of a civil action. These events may also lead to charges of homicide, manslaughter or criminal negligence (Daly, Speedy & Jacks...