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Assignment: Birth Control Leads To a Blood Clot Case Study

Assignment: Birth Control Leads To a Blood Clot Case Study


In a clinical setting, care services may be subject to errors which in overall, comprises the quality of life for patients. According to Brock, Nicholson, and Hooker (2017), a number of medication errors go unnoticed due to lack of adequate knowledge by patients about what constitutes malpractice. In a nutshell, medical malpractice is identified when a health practitioner neglects to give adequate treatment, proper action on care, or provide substandard treatment potential in causing harm, injuries or death to patients. In the event of perceived patient neglect or when a patient recognizes incompetency during care, then the receiver of care has all the rights to sue the medical practitioner or the health facility for causing harm to them. In the United States of America alone, over 250,000 patients die due to medication errors each year and about 440,000 cases reported on the same annually (Conrad & Valovska, 2018). Besides, according to the report from the Medical Malpractice Center, medical malpractice suits against physicians are at 85,000 every year. Nonetheless, malpractice lawsuits also target other health care providers such as Advanced Practice Registered Nurses (APRN) (Buppert, 2017). Even though the standards, as well as regulations with regard to medical malpractice, vary between states and countries, there is a concern that the numbers are on the rise. Besides, when a medication error occurs, it remains uncertain on the compensatory and punitive damages that accrue to either the plaintiff or complainant since malpractice lawsuits are costly, stressful and takes relatively longer to settle.

The present article piece focuses on a malpractice case study in a birth control ring involving an APRN and a patient. An overview of the case will be explored to identify an incident of malpractice. The analysis will also entail a description of the standards of practice from the American Association of Nurse Practitioners (AANP) to ascertain provider malpractice with regard to the case. An in-depth personal reflection on the malpractice case will be discussed to determine the outcome so as to make a conclusion about a settlement or jury award for the medication error. The study will be finalized by recommendations deemed fit to avoid future APRN negligence and malpractice.

Synopsis of the Case Facts

Ms. P was a 37-year-old nurse practitioner providing care service at a college clinic under the management of a hospital. In one of the days in early April, a patient named Ms. K sought the services of the nurse about contraception pills. The patient was an 18-year-old freshman who was in a relationship with another man but had no intentions to conceive soon. At the clinic, the nurse provides a range of contraceptive services including counseling to the students most of whom are presumed to be sexually active (Pelton, 2013).  In the case of Ms. K, the nurse described a variety of contraceptive options and after much deliberation, the patient opted for the NuvaRing. The latter is a hormone-containing ring that is inserted by a patient as a remedy to pregnancy. However, this type of contraceptive has adverse events, which include the risk of a blood clot (Grigg-Spall, 2013). During counseling, the nurse mentioned to the patient about this associated risk but failed to write the same on the patient’s record system (Buppert, 2017). When the nurse was certain that the patient understood all the necessary information about NuvaRing, she dispensed the medication to Ms. K and the latter thanked the nurse as she left the clinic.

After about two months and most specifically, on June 1, the patient returned to the college clinic but this time, she complained of shortness of breath as well as chest pain. She also informed the nurse about a feeling of tiredness and dehydration since she had not consumed any water despite being active over the weekend. As the nurse conducted her assessment, she realized that the patient had dry mouth, a chronic heart murmur and a family history of heart disease. The vital signs of the patient indicated a temperature of 97.90F against a heart rate of 76 beats per minute, the respiration rate of 16 breaths per minute and blood pressure recorded at 90/60 mm Hg.  The patient’s oxygen saturation rate was at 99%. However, while the nurse conducted her assessment, she did not realize that the NuvaRing was a potential factor in causing the patient’s symptoms. She went further to inform the patient to drink plenty of water, especially when was active and advised her to avoid intake of alcohol.

Within the same day and after seeking services from the nurse the patient consulted a pediatrician about the complaint within the clinic. The physician diagnosed Ms. K with exercise-induced asthma followed by a prescription of an inhaler even though the patient was not wheezing and has never had been diagnosed with asthma. The following day of June 2, the patient was presented at the emergency department of another hospital with the primary complain of chest pain together with shortness of breath as well as heart palpitations. On assessment, the health facility identified that the patient was using NuvaRing as a remedy for pregnancy. After a medical examination, Miss K’s EKG and vital signs were normal but was discharged without conducting a thromboembolism assessment.

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The next day on June 3, the patient returned to the pediatrician’s at the college’s clinic with a continued complain of chest pain. On assessment, the doctor identified that Miss K’s pain was persistent and was not related to exertion but attributed it to

Assignment Birth Control Leads To a Blood Clot Case Study

Assignment Birth Control Leads To a Blood Clot Case Study

costochondral pain. She was discharged but instructed to visit the clinic after 2 to 3 days especially if the pain persisted. Notably, on June 4, a physician who examined Miss K on June 2 during her emergency visit at the hospital called to report abnormalities in the patient’s EKG done during the visit and recommended that the patient be examined by a pediatric cardiologist. The patient made an appointment scheduled for the following week for further investigation of her EKG. However, two days prior to the cardiology appointment, the patient complained of chest pain and collapsed immediately at home. Miss K’s mother began a CPR as she called the emergency services. On medical assessment, the patient was shocked 3 times, which necessitated an administration of vasopressin and epinephrine as well as an admission to the wards.

While at the in-patient unit, the patient was unresponsive. A medical investigation using a CT scan indicated bilateral pulmonary emboli. In addition, an MRI of the brain performed to the patient showed changes and damages to the brains. EKG, on the other hand, confirmed severely diminished right ventricular function (Pelton, 2013). Due to embolism as a well as cardiac arrest, the patient was diagnosed for permanent brain damage, which meant that she required constant and around-the-clock monitoring in the care facility. Following this predicament, the patient’s mother hired an attorney on behalf of the daughter to sue Ms. P, the pediatrician as well as the hospital where Miss K sought emergency services. The plaintiff’s attorney filed a lawsuit citing allegations that the care facilities and the health providers failed to meet the standard of care for the patient (Buppert, 2017). The hospital requested the court to dismiss the case but the complaint was denied.

The Four Elements of Malpractice

At the care facilities, health professionals have an obligation to provide services as per the defined codes of practice and recommended guidelines. Based on the aforementioned case, four elements of malpractice can be identified. Failure to provide and document necessary information related to care was the first element of malpractice (Buppert, 2017). Miss P as the first care provider to get in touch with patient did not document the adverse events related to the use of NuvaRing particularly its association with a blood clot. This compromised the subsequent care, which led to the progression of the patient’s heart condition. According to Poghosyan et al. (2014), the second element of malpractice relates to misdiagnosis and this was done by the pediatrician who prescribed an inhaler after the wrong diagnosis of asthma. The third element of malpractice entails premature discharge and this occurred when Miss K was not admitted to a care facility despite her critical state during the second emergency visit at the hospital (McMichael, Safriet & Buerhaus, 2018). Finally, the fourth element of malpractice was identified when the care facility failed to order for appropriate tests especially the one related to thromboembolism investigation.

Standard of Practice from the American Association of Nurse Practitioners (AANP)

According to the AANP, a nurse is required to develop care priorities to a patient so that they can opt for the most affordable treatment process. Besides, care priorities also entail the provision of patient and family education regarding the chosen approaches of care (Yee et al., 2013). In this case study, care priorities were not given to the patient. The nurse went ahead to provide the contraceptive despite having adequate knowledge about the harms it might cause to the patient. Arifkhanova (2017) postulates that the other aspect on standards of care developed by AANP focuses on accurate documentation of patient status and care. This ensures accuracy in subsequent care practices. However, as per the case, the nurse failed to document the adverse events related to the use the contraceptive. This altered the subsequent care practices when Miss K was admitted to different hospitals. The records were not maintained by the nurse which was an indication of professional negligence. The nurse should as well show their responsibilities of being patient advocates (Buppert, 2017). This means that nurses should ensure that the care provided optimizes safety and quality of patients. In the present case, the nurse failed to provide adequate information on the adverse events that might affect future intervention. She, therefore, did not have the interest of the patient at heart to warrant the provision of quality care.

Strategies that Could Have Been in Place to Avoid the Malpractice

The clinic operated as a subsidiary of the main hospital to provide care to college students. The hospitals ought to have outlined the standard practice of care for the nurse in the clinic (Buppert, 2017). This could have been achieved by providing the most recommended contraceptive to students as opposed to the NuvaRing that have adverse reactions. In fact, the health facility ought not to avail the NuvaRing medication to ensure that it was not administered to the patient.

Why the Strategies Were Not Implemented

The strategy was not implemented since the adverse effects of NuvaRing was not determined by the institution. In essence, different contraceptive drugs have a varied reaction to patients and this means that the harms of the medication could not be predicted. However, the strategy could also not be implemented because the decision on the choice of the contraceptive was made by the patient (Arifkhanova, 2017). It, therefore, means that the patient was already aware of the repercussions on the choice of the drug.

A Determination on Whether Provider Practiced Within the Professional and Individual Scope of Practice

The nurse practitioner did not provide services as per the professional and individual scope of practice. This mainly happened when she failed to perform appropriate documentation on patient care as per the recommended standards of practice. Besides, despite having knowledge of adverse events in the use of NuvaRing, she still went ahead to recommend the medication (Grigg-Spall, 2013). The pediatrician as well did not emulate the provider scope of practice when the doctor prescribed inhaler after a false diagnosis of asthma. All these are indicators of professional negligence and malpractice which led to a medication error that compromised the quality of care for the patient.

Analysis of the Outcome of the Case

In the aforementioned case study, triable issues of fact can be identified to ascertain professional negligence and malpractice. A factual dispute is identified in the manner in which the nurse violated the professional code of practice as she failed to document the side effects of NuvaRing. She was responsible for all the predicament that faced the patient due to this gross professional misconduct. The pediatrician as well has a case to answer for the wrong diagnosis of asthma and wrong prescription of inhaler (McMichael, Safriet, & Buerhaus, 2018). The intention of the hospital’s attorney for the case of malpractice to be dismissed is therefore unwarranted. Miss K was the recipient of inappropriate medical intervention and therefore must be given justice to compensate for her unfair treatment.

A Reflection on Personal beliefs based on the present case

In determining a summary judgment for a medical malpractice case, one must assess the issues of facts to institute a lawsuit. This means that the incidences must have occurred and that the evidence must be ascertained. In this case, there is clear evidence that the nurse and the pediatrician violated a standard of care for the patient (Poghosyan et al., 2014). The defendants need to establish the reasons why they should not be prosecuted. Besides, they cannot depart from accepted codes of medical practice or deny the proximate cause of the injuries to the plaintiff. As per this case, the nurse moved from a summary judgment by asserting that she did not violate the accepted standards of care. However, her NuvaRing prescription led to the proximate cause of the patient’s injuries.

Conversely, information from expert opinion affirmed that the nurse was not aware that the contraceptive could lead to pulmonary embolism and as such, it was not the proximate cause of the unprecedented injuries to the patient. Even though the nurse can defend herself, she also violated the standard of care especially when she failed to refer the patient for further medical intervention during the second admission of the patient. However, the need for Ms. P to refer Ms. K for further intervention can as be inconsequential since the latter had visited the pediatrician and the physician was in the right position to determine the patient’s next course of care (Conrad & Valovska, 2018). Arguably, the nurse ought to have removed the NuvaRing on June during the second visit of the patient and following Miss K’s complains that indicated symptoms of heart conditions. The nurse, therefore, was liable for the proximate cause of injuries to the patient.

Recommendations as a Remedy to Negligence and Malpractice

Medication errors resulting from negligence and professional malpractice affects the course of care for patients. As per this case, several steps can be undertaken as a remedy to malpractice. In the first case, a nurse should always document the type interventions administered to the patient on the patient’s records (Brock, Nicholson, & Hooker, 2017). This should also incorporate a consent form to ascertain that the patient accepted the type of care given. Secondly, Yee et al. (2013) posit that nurse and other care providers should ensure that they keep diligent and complete records about patients. This has a dual purpose of ensuring continuity of care and also protects the professional reputation of a practitioner. Thirdly, when a nurse is prescribing hormonal birth control, care should be taken about the danger of blood clots (Pelton, 2013). As such, it is important to assess the medical history of heart disease before making a decision on prescription (Buppert, 2017). Besides, if a patient using hormonal birth control medications present to a care facility with chest pain and difficulty in breathing, it is important to refer the client for further medical evaluation.


Medical malpractice has a dual impact since it causes harm to the patient and also ruins the professional practice of a care provider as well as the institution. As per the preceding illustrations, malpractice and negligence arise when a health professional fails to follow the standard practice of care to warranty safety to patients. As illustrated in the discussion, nurses should ensure proper documentation of patient records to protect their reputations. However, before considering filing a lawsuit on malpractice, one must have triable issues of fact to ensure justice is served for both the plaintiff and defendant. In overall, negligence and malpractice in a care setting are detrimental and care providers should emulate professional curiosity to ensure competent health service delivery to patients.

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