Introduction
The case study presents a malpractice action brought by Yolanda Pinellas, a 21-year-old female studying to be a music conductor, against the healthcare provider responsible for administering chemotherapy treatment. The patient developed necrosis of the hand after the IV infusion was discontinued due to IV infiltration. This paper discusses the standards of care violated in this case and the responsible parties. It also examines the risk management steps a nurse practitioner should take before or after the incident to alleviate the issue.
Standards of Care Violated and Responsible Parties
In this case, a number of standards of care were violated, some of which have been described below. One of them is failure to adhere to the standard of IV medication administration. The nurse administering the mitomycin via the infusion pump was responsible for ensuring that the medication was being administered safely and accurately. In this case, the infusion pump began to beep, indicating an issue with the medication administration. The IV infusion was discontinued due to IV infiltration, and the pump was not adequately monitored, leading to necrosis of the patient’s hand(Weingart et al., 2018). However, the nurse only discontinued the infusion and did not take any further action to investigate the issue or assess the patient’s condition. This failure to act violated the standard of care for medication administration.
Secondly is the standard of care for IV therapy. IV therapy is a critical aspect of patient care, and established standards of care must be followed to ensure safe and effective IV therapy. One of these standards is to monitor the IV site regularly for signs of infiltration or extravasation (Weingart et al., 2018). In Yolanda’s case, the documentation in the medical record indicated an IV infiltration, yet no further action was taken to address this issue. This failure to monitor the IV site and take appropriate action violated the standard of care for IV therapy.
Lastly is the standard of care for staffing. The risk manager noted the use of float nurses and short-staffing issues during their charts review. Staffing is essential in ensuring patient safety, and there are established standards of care for appropriate staffing levels (Cho et al., 2019). Patient safety can be compromised when adequate staffing levels or float nurses are used. In this case, the staffing issues likely contributed to the failure to follow the standards of care for medication administration and IV therapy due to the risk of burnout related to double shifts.
The responsible parties, in this case, are the healthcare provider responsible for administering the chemotherapy treatment, the nurse who discontinued the infusion, and the physician who was notified of the incident. The nurse violated the standard of care by not adequately monitoring the infusion pump and discontinuing the infusion without taking appropriate action to address the IV infiltration (Cho et al., 2019). The physician failed to take timely action to prevent or treat the necrosis, resulting in the patient’s permanent loss of function and deformity.
Risk Management Steps
As a nurse practitioner, several risk management steps can be taken before or after the incident to alleviate the issue. Before the incident, the nurse practitioner should ensure that the healthcare facility has adequate staffing levels to meet the demand for patient care (Tariq et al., 2020). This would prevent nurses from working double shifts and reduce the use of float nurses across several units, ensuring patients receive continuity of care from qualified professionals.
In addition, the nurse practitioner should ensure that all healthcare professionals involved in administering chemotherapy treatment receive adequate training and education on the proper use of infusion pumps and managing IV infiltrations. This would ensure that healthcare professionals adhere to the standard of care in delivering safe and effective patient care. After the incident, the nurse practitioner should participate in a root cause analysis to identify the cause and develop a corrective action plan to prevent similar incidents from occurring in the future. The corrective action plan should involve implementing policies and procedures for monitoring IV infusions, ensuring adequate staffing levels, and providing ongoing training and education for healthcare professionals (Tariq et al., 2020).
Specifically, to prevent IV infiltrations, policies should include using a trained and qualified nurse to monitor the infusion pump and a protocol for prompt action in case of infiltration. A checklist should be in place to ensure that the patient’s IV site is appropriately assessed and monitored before, during, and after the infusion. A quality assurance program can review the compliance of these protocols and provide ongoing education to healthcare professionals to maintain their knowledge and skills (Tariq et al., 2020).
Furthermore, the nurse practitioner should ensure that healthcare professionals involved in administering chemotherapy treatment are aware of the potential risks associated with chemotherapy treatment and the importance of timely intervention in addressing any adverse events that may occur. This would ensure that healthcare professionals have the knowledge and skills to provide safe and effective patient care.
Conclusion
The malpractice action brought by Yolanda Pinellas against the healthcare provider responsible for administering chemotherapy treatment highlights the importance of adhering to the standard of care in delivering safe and effective patient care. The nurse, physician, and healthcare provider were responsible for the patient’s injuries due to inadequate monitoring of the infusion pump and delayed intervention to prevent or treat the necrosis(Cho et al., 2019). As a nurse practitioner, it is crucial to take appropriate risk management steps before or after an incident to alleviate the issue and ensure patient safety. By doing so, healthcare professionals can deliver safe and effective patient care, ensuring that patients receive the best possible outcomes.

References
Cho, S., Lee, J., You, S. J., Song, K. J., & Hong, K. J. (2019). Nurse staffing, nurses prioritization, missed care, quality of nursing care, and nurse outcomes. International Journal of Nursing Practice, 26(1). https://doi.org/10.1111/ijn.12803
Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2020). Medication Dispensing Errors And Prevention. PubMed; StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/30085607/
Weingart, S. N., Zhang, L., Sweeney, M., & Hassett, M. (2018). Chemotherapy medication errors. The Lancet Oncology, 19(4), e191–e199. https://doi.org/10.1016/s1470-2045(18)30094-9