Nursing Experts Opine on Failure to Treat Ongoing Infection

This case involves a female patient with a history of renal failure who was admitted to hospital for dialysis. She an elevated white blood cell count and severe swelling and pain in her feet, as a result she was started on antibiotics. While on the dialysis unit, she informed the dialysis nurses about the sore on her foot. The patient was informed that there was no one available at that time who could see to her feet. The patient made multiple complaints about the foot pain and swelling, but she did not have it examined. By the following day, the patient’s lower leg had turned purple, and the discoloration spread over the course of the day. At some point that day, an infectious disease physician was called in on a consult, and noted that a wound care consult ought to be obtained. Despite this recommendation, no consult was arranged. The following day the patient’s leg was black. Eventually, the patient underwent an amputation of her foot.

Question(s) For Expert Witness

1. Do you routinely treat patients like the one described in this case?

2. Have you ever had a patient develop this outcome?

3. What is the responsibility of the nursing staff to escalate a patients concerns in case such as this?

Expert Witness Response E-011203

I teach in a doctoral nurse practitioner program and also work in a busy emergency room. We often encounter patients on dialysis, patients with cellulitis, and patients withe fever and elevated white blood cell counts of unknown origin. Several important factors were ignored in this case. The lack of attention to the foot by the nursing staff was pure patient neglect. Additionally, it would be interesting to see the physical assessment documentation by the nurses regarding the foot over the several shifts this situation covered. The fact that there was a change in the patients condition was justification to bring this issue to the primary physician on record for this patient. The infectious disease physician could and should have ordered a culture of the wound to ensure the organism causing the infections was sensitive to the current antibiotics that were being given. Further negligence is noted by the infectious disease physician not ordering a wound care consult rather than just noting that one should be obtained. Lastly, the nurses have a duty to clarify as to whether they were to initiate the wound care consult or if this had been completed. Overall, it appears that a blatant lack of regard for this patients care and a lack of follow through resulted in her losing her foot.