Nurse Discontinues Telemetry Order Without Physician Approval

ByVictoria Negron

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Updated onApril 10, 2018

Nurse Discontinues Telemetry Order Without Physician Approval

This case involves a female patient with COPD who was administered large amounts of tranquilizers. The physician ordered the patient to be placed on telemetry, however, the nurse on call discontinued the order without the doctor’s confirmation. Hours after receiving the tranquilizers, the patient was in cardiac arrest. The patient was resuscitated and intubated but turned blue and passed away before the physicians could move her to the intensive care unit. It was later discovered that the nurse had placed the endotracheal tube in the patient’s esophagus instead of the trachea. An expert in nursing with a great deal of experience working in a telemetry unit was sought to review the records and opine on the standard of care.

Question(s) For Expert Witness

1. Please describe your background in nursing.

2. What is your experience working on general medicine floor and in a telemetry unit?

3. If a physician orders a patient to be moved to a telemetry setting, is the nurse able to cancel that order without informing the physician?

4. After a patient is intubated, whose responsibility is it to check for proper tube placement?

Expert Witness Response E-122210

inline imageI have been a nurse for 22 years in a variety of care settings with a variety of patient populations. I currently cover the entire spectrum of hospital care. I have represented plaintiffs who have expired as a result of hospital negligence. In this situation, based on what you have provided, the nurse would not be able to D/C telemetry without an order from a provider. Had this patient been on the ordered monitoring with alarms on, the staff would have been notified when heart rate or oxygen levels dropped. During a code, typically the respiratory therapist does the initial placement check by listening for bilateral breath sounds, and either the provider or respiratory therapists will place a commercial end CO2 detector on the endotracheal tube. Once the crowd clears, it becomes the nurse's responsibility and the respiratory therapist's responsibility to confirm a patent airway. The nurse would be monitoring vital signs, including oxygen and clinical assessment. The provider would order a chest X-ray to confirm as well. This should have been completed after the transfer to ICU because moving the patient can dislodge the tube. One would think that if they suctioned the endotracheal tube, which they should have done, they would likely have gotten stomach secretions. In the ICU, the patient should have also been on end tidal CO2 monitoring, especially given the COPD. In regard to being on telemetry D/T large doses of benzodiazepines, this would depend on PT history, ordered dose, and frequency.

About the author

Victoria Negron

Victoria Negron

Victoria Negron has extensive experience in journalism and thought leadership in the legal space, with a background crafting content, whitepapers, webinars, and current event articles pertaining to the role of expert witnesses in complex litigation matters. She is a skilled professional specializing in B2B product marketing and content marketing. Currently, she serves as an Enterprise Product Marketing Manager at Postman, and previously held the position of Technical Product Marketing Manager at Palantir Technologies, where she developed her skills in launch strategies, go-to-market strategy, and competitive analysis.

Her expertise in content marketing was further refined during her tenure at the Expert Institute, where she progressed from a Marketing Writer to Senior Content Marketing Manager, and eventually to Associate Director of Content & Product Marketing. In these roles, she honed her abilities in digital marketing, SEO, content strategy, and thought leadership.

Educationally, Victoria holds a Master of Business Administration from the University of Florida - Warrington College of Business and a Bachelor of Arts in Literature, Art, and Hispanic Studies from Hamilton College. Her diverse educational background and professional experience have equipped her with a robust skill set in product marketing, content development, and strategic marketing initiatives.

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