Why the nurse is not to blame for the Ebola “mistake”

There is a lot of talk about why the man diagnosed with Ebola at Texas Health Presbyterian Hospital was sent home from the emergency room not having been tested for Ebola despite telling the triage nurse he had been in Liberia.

Because they let him go, he came in to contact with up to 20 people including a handful of school aged children. According to CNN, “Hospital officials have acknowledged that the patient’s travel history wasn’t “fully communicated” to doctors” (CNN article). CNN also reports that “‘A travel history was taken, but it wasn’t communicated to the people who were making the decision. … It was a mistake. They dropped the ball,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.”

“They dropped the ball”. I certainly hope Dr. Fauci is not talking about the nurse.

Don’t get me wrong, internal communications, or lack thereof, is a very serious problem in healthcare today. And the common patient is often unaware of this. To the patient, if you tell one person, they will tell the others. Unfortunately, as we all to well know, this isn’t always the case.

The nurse was following a check list which asks about foreign travel as a part of the history taken on each patient with infectious symptoms. He or she must have documented this in a computer chart but they must not have verbally told the doctor. To be completely safe, a patient presenting with these symptoms with a travel history from Liberia who had contact with someone who died of Ebola should have been immediately put on contact isolation pending testing. But for this, we should not blame the nurse.

Each doctor is supposed to take their own history as a part of the examination of the patient. The fact that the emergency doctor or doctors did not take a thorough history is not the fault of the triage nurse. In fact, this isn’t a “communication” problem at all. It is an examination problem. For reasons unknown, because it hasn’t been addressed in the media, the doctor simply failed to ask the right questions.

This was a mistake, and hopefully not a deadly one. 80 people are now being monitored for signs and symptoms of the disease for the next 21 days, the incubation period of Ebola. They likely will be just fine. It is an unfortunate circumstance. BUT, lets not default to blaming the nurse.

8 Comments on “Why the nurse is not to blame for the Ebola “mistake”

  1. actually, I was thinking about this. If this was a checklist, it was likely on an electronic record, so the doctor should have READ IT. I highly suspect that no one read the nurse’s assessment of the patient. The checklist is USELESS if no one reads it.

    This is all about collaboration, and collaboration is not just verbal…

    the whole reporting is clearly trying to blame a nurse, where this is not only a system failure, but a BIG problem in interdisciplinary care

  2. Did Ebola not warrant more then a little blip on a computerized record? Should the nurse maybe have been a little more proactive? I think we are dealing with a situation that calls for more then just another dummy proof nursing check list. If you say that the patient should have been placed in isolation, why did it not happen? This is a failure of the entire team, doctors and nurses. All healthcare providers share in the responsibility for this mistake. I take that back, a mistake would be spilling your milk. This is a case of negligence and failure to perform if I’ve ever seen one. Any person who had a responsibility in dealing with this patient should be investigated for competence and promptly fired for cause. A standard level of teamwork, knowledge, communication, common sense, and duty must be maintained at all times and Dallas Presbyterian staff has failed.

    • I think we should all be VERY CAREFUL in making assumptions and assigning blame in the Dallas Ebola incident. It is becoming increasingly clear that this is a systemic problem –EHR design and use. but things like this have always happened where the medical record is split into disciplines instead of running in real time. Also, as with all sentinel events, it is not going to be any one person, but breakdown of a system–or lack of a system.
      I would caution everyone to remember that we were not there when this ER did their eval, we don’t know how many patients were stacked up, what the staffing was, what the level of communication is in the unit itself. There is lots to look at. But we, as nurses, need to start to INSIST that we are at the same table as doctors and administrators. We need to stop talking about how nice we are, and how much we care. We need to be professionals and point to our value, our education, our training and experience. We need to insist that our colleagues practice to the full extent of our education and certification. We need to STOP denigrating each other and insist on quality and competence.

      • Very good points. I would only offer that patient count and staffing are not proper reasons for any breakdown at all. “We were busy” should never ever ever cross anyone’s mouth for justification of missteps in a critical incident. My original point of my first post was trying to convey there were numerous failures. The public expects and deserves top level care and teamwork no matter how busy we are and what computer boxes we tick. This isn’t a broken bone, this is a virus with a reported fatality rate of 50 – 90%. It is time to change with the growing threat or risk being left in the lurch.

  3. I disagree. They did drop the ball. Anyone with a decent common sense who finds out that a person who just traveled from Liberia (an area that’s been in the news due to the outbreak) and is ill should be enough for someone to suspect something serious. The nurse could have said to her senior or to a doctor that the man was ill and had traveled from Liberia. That patient should have immediately been quarantined until further tests were made. There’s no excuse for this and they are every bit accountable of the decisions they made.

    Second of all, who prescribes antibiotics for viruses? Antibiotics only work on bacterial infections. This over-prescription of antibiotics is mainly to blame why we’re also seeing stronger MRSA strains emerge.

  4. We are so enamoured with technology and emr that we have lost a gift of humanity. Talk about common sense? After reading and reading ehr reports the mind is cloudy so that common sense is dulled. That nurse did her duty, fill out the template, follow the algorithn. We drift into that mode: template thinking, not cognitive. Do it because we are chasing MU dollars. Get home on time. The more we do the template and fill it full of dribble, the less we have time for direct patient care, to talk with each other, exchange dialog.

  5. Pingback: Ebola Outbreak: Don't blame the nurse - Sarah Beth RN

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