The RN will remain with the patient post procedure, performing continuous monitoring of hemodynamic status and responsiveness. It is beyond the scope of practice of an LPN to monitor a patient under conscious sedation. The emergency department becomes busy Additional staff from another department

ORGANIZATIONAL SYSTEMS TASK 2 with extra patients, including one brought by EMS who is respiratory distress. The RN becomes targeted on that patient and has not been monitoring Mr. B. should have been utilized so that Nurse J could remain with Mr. B, per policy. Respiratory therapy should have been notified of the emergency patient’s imminent arrival. Mr. B’s son informs Nurse J that the “monitor is alarming”. The blood pressure monitor displays the latest result (58/30) with a pulse oximetry reading of 79%. Patient is not breathing and has no pulse. STAT CODE is called. The RN will remain with the patient post procedure, performing continuous monitoring of hemodynamic status and responsiveness. An emergency cart must be within immediate access where sedation is administered. The cart must include emergency resuscitation drugs – including reversal agents, airway equipment and supplies, a defibrillator, and oxygen. Ambu-bags and suction supplies must be available and ready to use. Respiratory therapy, or someone who is proficient in emergency airway management, must be available on-site. Only Nurse J is reported to have completed the hospital’s moderate sedation training. Only Nurse J is reported to have ACLS certification. “All practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module” (scenario). Step three involves asking the five why’s which are tied to seven factors: patient characteristics, task factors, individual staff factors, institutional context, work environment, organization and management factors, and team factors. Following these guidelines, the why’s

ORGANIZATIONAL SYSTEMS TASK 2 are identified as: failure to follow policy standards (organization and management factors); low staffing in ED, one RN and one LPN, emergency cart and equipment not made available (work environment); conscious sedation practices beyond the scope of practice of LPNs, probable increased stress and fatigue levels due to low staffing issue (individual factors); verbal report given to Dr. T may not have been complete regarding patient’s history, protocols were not followed (task factors); when ED became busy, available staff was not utilized, Dr. T did not review patient’s chart prior to the procedure (team factors); patient was elderly and had a medical and medication history that should have alerted the staff that the medication doses, or the actual medications, should have been taken into consideration and possibly changed (patient characteristics).