As a nurse myself, the "nurse didn't pass the Liberia information along" blame bothers me

[rainbow4321]

Yes, she was PART of the process but the buck shouldn't stop with just her. She triaged him, took the cursory info, BUT the medical provider who saw the patient is responsible for doing a complete history and physical assessment, independent of that triage information. Any medical provider who relies on ONLY cursory information from a 3rd party to diagnose and treat has no business being in healthcare. Sounds like the hospital is wanting to pick someone low on the food chain to blame so their ER DOCTORS don't take any blame.

Now having said that...if that nurse took the triage info and sent the patient back to the waiting room instead of to an isolation room, then, yeah, that is on her/him. Cleary he or she did because had the patient been put in an isolation room immediately that would have been a red flag to the rest of the team that night.

Definitive info can only be gotten from everyone's charting for that first visit...but mainly what did the medical provider who dispensed the antibiotic wrote in his or her notes for the history and physical.

[YarnAddict]

1. Understaffed and overworked? n/t

[MohRokTah]

2. I'm willing to bet she/he entered the information into the electronic medical record.

I'm further willing to bet the doc did not read the notes of that record where the fact that he had traveled from Liberia was recorded.

Having spent several years working in a hospital, it always seemed that protecting the docs was priority 1 for the hospital

[kelliekat44]

33. How many times do ER doctors ignore the written reports, come in and ask the same questions,

then give THEIR diagnosis, order tests and walk out until test results are in? That's been my experience.

[bullwinkle428]

3. I'm thinking the lack of insurance thing plays into this. The triage

nurse will probably be the "fall guy" for this, just like some low-level employee of the NFL will, for the Ray Rice video supposedly never making it to Roger Goodell.

And again, as I've been saying over and over in these threads, which idiot doctor made the decision to give him anti-biotics to treat a viral condition?

[Sheepshank]

4. my experience with nurses=positive. Doctors, not so much.

perhaps the doctors are over worked and busy, but the "God Complex" in many of them, precludes their desire to humanize their patients and delve into backgrounds. If the patient's travel info was in caps on the chart, it could easily have been ignored.

[Orrex]

5. Yeah, it's funny that they blame the one person who asked the question

Rather than the 20 who didn't.

[valerief]

26. Like cops, docs and administrators protect their own. nt

[rocktivity]

6. The patient said he told the hospital he'd come from Liberia

But if he didn't also tell them that he'd been in contact with two Ebola patients that had died, he's to blame, too. But he also should said something before leaving Liberia, too.


rocktivity

[DustyJoe]

13. plus

What's the chance that him coming from a foreign country that his language skills in english or a heavy dialect or accent that he could have been misunderstood by non Liberian descent people ? So many possibilities.

I suppose a review of his triage questionnaire answers would prove his claim he told the triage nurse of his Liberian exposure and that she understood him and entered it into the record for downline care personnel.

[hugo_from_TN]

15. The official language of Liberia is English

[uppityperson]

19. There are a lot of different languages in Liberia and a lot of people who don't speak English

Americo-Liberians and those who deal with them in the cities, yes. But up country? Out in the villages? Not so much.

[morningfog]

34. Two patients? Who was the one other than

the pregnant woman who he held by the legs?

[kestrel91316]

36. In the guidelines, action is triggered when fever and travel involving nations with Ebola

are in the same room. So to speak. Exposure is irrelevant to triggering action, though it does affect what sort of action might be taken.

[TwilightGardener]

7. It's always a chain of errors. But yeah, if that nurse didn't immediately see red flags

with "vomiting, diarrhea, fever, and I just got back from West Africa" and move quickly to isolate the man and let other staff know immediately, then he or she blew it big time. Some people really just don't watch the news, have no idea what's going on in the world, and it sounds like the hospital didn't give the triage and ER personnel any special heads-up on ebola.

[rainbow4321]

10. Hospital is downplaying the initial visit symptoms

Saying he "only" complained about abdominal pain and a "low grade fever". Gee, where have we seen THOSE symptoms?? Oh, that's right...on the fucking Ebola list of potential symptoms.

I'm thinking they took the cheapest way out...no stool samples, no CT scan, very little if any bloodwork.

Just give him a bottle of whatever pills and "go see your primary if not better."

They can't have it both ways..if they thought stomach virus, why give the pills??

[TwilightGardener]

17. I guess the docs just throw bottles of broad-spectrum antibiotics at people who come in

with fevers and vague symptoms, hoping it's bacterial and that the AB's will work.

[ladjf]

8. I know that the victim told someone at the hospital that he had recently

arrive from Africa, but did he explain that he personally had helped carry a woman who had ebola to a car? That woman died a couple of days later.

[Avalux]

9. If it isn't documented, it didn't happen.

Somehow, that medical history information didn't get to the treating physician. Either the nurse didn't document it, or the doc ignored it. Which is it?

I'm sure you're a responsible nurse, but not all of them are. If the ER was really busy at that time, it's possible she didn't do her job. But to your point - usually the doc takes their own med history, and asks the same questions as the triage nurse. So even if she dropped the ball, the doc should have asked too.

[oldandhappy]

11. I am sure the nurse did everything correctly.

I suspect the next person did not read!!! I have had to repeat things lots of times. Maybe OK to be sure you have the right patient. And, maybe, can't read.

[shraby]

12. Let's face it, 5 minutes allowed by ins. companies and hospitals, for a doctor to see and

evaluate a patient is not enough time for anything more than a "look in the ears, listen to the heart, look down the throat" type of examination.
The doc. scans the info sheet as they are walking into the room, also not enough time.

[riverwalker]

14. BTN "blame the nurse"

that's what I thought. She probably wrote it in her admission notes, which the MD's don't always read. No ones at fault, they are all busy, but so many times you have to chase down the doc and tell him face to face important info, because even though you charted it, no one has time to read everything.
FYI. Our lengthy admission "check list" does not contain ANY questions about recent travel, and we are not the only hospital that does not ask.

[kestrel91316]

37. Well, you'd better start asking. Or be prepared for the lawsuits.

[riverwalker]

16. I keep thinking about the lab techs

he probably had blood drawn by several different people, all those little vials of blood, being handled and processed by many unaware different people, in the lab, by the overworked techs that drew them, the disposal of the equipment used. They wear gloves, which are tossed in the waste can, dropped on the floor. How many times do I see visitors let babies play on the hospital floor?. Those little vials of blood, the potential for so much destruction, and the people unaware of what it was in their hands.

[uppityperson]

20. I keep thinking the way this will really get out of hand, so to speak, is blood in vials

being "lost" and used to contaminate others. Yes, tinfoily for sure, and doubtful it'd happen, but it is my fear, some jerk will take advantage of the situation and use this to close down some city.

[FarPoint]

21. OMG. yes.....

The endless trail....understaffed, cutting corners just to get done....who knows what will follow...

[jwirr]

18. I have been one who criticized her. I am sorry for that. What we need is more information about

what actually happened.

[meadowlark5]

22. Why didn't Duncan himself mention it to the doctor as well?

So he told a nurse, if he was really concerned it could be ebola and concern for his own safety, when the doctor told him it was a run of the mill virus and here's some antibiotics, why didn't Duncan ask, "are you certain? I just came from Liberia where I carried a woman who died of ebola an hour later?"

There is so much that went wrong here.

[summerschild]

23. I bet a dollar to a donut the guy thought he had Ebola when he first went to the emergency room.

I just read on facebook that Liberia plans to charge him for lying on his health form. He knew how much at risk he was - people were dropping dead all around him like flies. Things I read early on said he made a rapid decision to leave Africa. He was trying to escape. I'm not blaming him - I might as well.

I expect many more will do the same - if they can afford it.

ANYONE working in a hospital setting (especially in an emergency room) who doesn't understand why they are asking the question about travel is too dumb to be working anywhere.

[Warpy]

24. Me too, because it's bullshit.

For one thing, it had to be on his paperwork along with the word that really kept him from being admitted: uninsured.

"Blame the nurse" is a game a lot of docs play when they've blown off importatnt information. They're usually the docs who graduated at the bottom of the class, I've noticed.

[AverageJoe90]

25. I see what you're saying. She may not have shared any responsibility for this after all.

We need to look at the doctors and the other providers as well. What did they do?

[ecstatic]

27. My family is full of nurses and

the whole thing sounds fishy and hard to believe.

However, if the story that's circulating is true: That a nurse actually documented that Duncan had recently been in Liberia/West Africa, but was not conscientious enough to fully absorb the information and warn the staff, or even protect him/herself, then s/he shouldn't be working in a hospital. I understand that people are overworked and tired, but the ER is no place for absent minded/distracted people.

[seabeyond]

30. read my post two down, #29. not being in the field myself, but still, i see it like you. nt

[valerief]

28. Trickle down blame. Shades of Abu Ghraib, Lynndie England. nt

[seabeyond]

29. you being a nurse, this is what has me wondering.

i have to assume especially in medical environment, we are all pretty aware of the basics with the ebola issue. it certainly has been in the news and discussed enough. and being in the field, i would expect it to peak interest. in case they were not educated at the hospital itself. awareness would still be there.

if i got a patient with fever, and nausia, found him from a hot spot, concern for my safety would be top. isolate. yes, the waiting room. but wouldnt you be talking among the other nurse, doctors and medical help. passing the info along to everyone you see? wouldnt in that environment it be a hot topic? even busy. the people are passing here and there.

a possible first case in the u.s. that is what i do not get

[treestar]

31. +1

There are people who pay little attention to the news, but it would be epic levels of apathy not to realize hey we're having something to do with this very hot topic. The whole place would normally light up at the idea someone just from Liberia was even there.

[seabeyond]

32. you would think. and i have been in that environment enought o know, even busy, a good gossip topic

is still discussed adn everyone in this small community is hearing the stories in passing. one would think, at the least, a possible ebola case would warrant the same gossip chain, and someone screwing someone else.

[kestrel91316]

38. People in healthcare, specifically ER screening nurses, who do NOT pay attention to health news

need to find another line of work. Because they are a menace to society.

[kestrel91316]

35. Federal guidelines specify that if you have fever and West African travel in the same room,

you grab the PPE, slap a mask on them, stash them safely, alert hell out of everyone, and ask questions later.

The hospital violated those guidelines. The nurse dropped the ball. The hospital needs to be sued out of existence. There is simply no excuse.

Pointing the finger at some computer or "failure to communicate" simply won't cut it.