What Is an Ethically Informed Approach to Managing Patient Safety Risk During Discharge Planning?
Year: 2020
Type: article
Abstract: Hospital discharge planning for patients who might not be safe at home-particularly those leaving against medical advice-can require risk managers to navigate the complex intersection of tort law, federal and state regulations, and clinical ethics.An overarching duty is to ensure that a patient is as safe as possible in the environment to which the patient is being discharged, although it's not always possible to formulate a safe discharge plan.When patients have decision-making capacity, they can make a decision to be in an environment that's not safe.When patients do not have decision-making capacity, it is not always legally permissible to hold them against their wishes to keep them in a safe environment, so some kind of discharge plan must be made.This article considers the role of a risk manager in navigating this set of circumstances.Case RQ is a 32-year-old man with end-stage multiple sclerosis (MS).He lived independently until 5 years ago, when his condition became worse and he had to be hospitalized several times.RQ was then cared for in his home by his parents and sister, with support from a home care agency.Early in his most recent hospitalization, RQ suffered severe respiratory distress, was intubated, and was placed on a ventilator.RQ's body language adamantly and persistently expressed that he did not want to be intubated.But Dr C, a pulmonologist in the intensive care unit (ICU), expressed confidence that RQ's current respiratory condition was temporary, with a solid chance of remission.No advance directive existed in RQ's electronic health record (EHR), and Dr C was convinced that RQ lacked decision-making capacity at this time.Dr C and RQ's parents agreed that ventilator support should continue.As RQ's hospitalization continued, his condition deteriorated, and he became more agitated.RQ was sedated, a line was inserted for hyperalimentation (intravenous nutrition), and a tracheostomy tube was placed.He suffered several nosocomial infections, including methicillin-resistant staphylococcus aureus.After 80 days in the ICU, RQ's condition stabilized enough for him to be weaned from the ventilator.After 81 days, RQ plugged his tracheostomy tube to speak; he stated clearly and deliberately, "I
Source: The AMA Journal of Ethic
Author: John C. West
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W3096993127