A team of ICU nurses was named in a medical malpractice lawsuit after one of their patients passed away from a previously undiagnosed heart condition. The patient had been experiencing breathlessness and heart palpitations, and needed a valvuloplasty to re-open his constricted aortic vein. His cardiologists assessed that he would require aortic valve surgery, which was allegedly performed without any complications. Nevertheless, he began to have declining health in the weeks after his surgery, and was readmitted after his blood pressure lowered and his heart began to go out of rhythm, entering atrial fibrillation. His cardiologist allegedly requested the ICU nurses to perform an echocardiogram to assess the patient’s heart multiple times in the course of a week; however, no scan was ever completed, and the patient quickly expired from the effusion of fluid into the membrane surrounding his heart. An expert in critical nursing care was asked to discuss the case, and whether his nurses had neglected a standard of care for their patient.
Question(s) For Expert Witness
1. What is your experience caring for a patient in the ICU with the diagnosis of atrial fibrillation recently after cardiac surgery?
2.What is the role of the ICU nurse in ensuring that the patient receives the required diagnostic procedures and tests that have been ordered?
Expert Witness Response E-000437
I have taken care of many patients with atrial fibrillation following cardiac surgery. The ICU nurse is responsible for notifying the ICU attending doctor or the appropriate physician of abnormal vital signs and abnormal physical findings as noted in the scenario - it must be done immediately so the physician can examine the patient and provide appropriate orders. When a patient has atrial fibrillation, a known history of cardiac surgery, and possible sepsis, it is imperative the Echocardiogram is performed as ordered, and in this case, the ICU nurse should have made sure the test was performed and the results communicated to the physician immediately.
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