Unit 3: Failure to Monitor
UNIT 3 CASE STUDY
Failure to Monitor
Nick Myrick
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Abstract
I will attempt to identify the parties involved, the facts, the significant fact and the reason
for certain action in the case of failure to monitor. Furthermore, I will discuss legal issues
represents and the possible arguments with respect to the most compelling argument, the impacts
to society and the HIPPA implications.
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UNIT 3 CASE STUDY
Failure to Monitor
Data Gathering
After reading the case, Failure to Monitor, The parties involved are the patient as the
plaintiff, the pharmacist as the defendant. Other parties involved are the physician, the home
health service, the hospital, the laboratory, HHS nurses, and the hospital pharmacist. The
pharmacist is the head pharmacist and the director of the pharmacy. The HHS provides home
health care to patients including dispensing and administration of oral and parenteral
medications, nursing care, personal care services, and case management.
There are many facts in the case. A patient developed a rash and fever in one day. The
patient did not report the problem to the pharmacist but was seen by the physician. On the
second day, the physician treated the rash and fever with an unknown medication. The
symptoms continued to day 9, and a bone scan was ordered and performed. The patient was
diagnosed with osteomyelitis, and was admitted on the following day, the tenth day. During the
hospital stay the patient received Vancomycin and Gentamicin in combination to treat his
condition. The dosage and response to treatment was monitored by the physician and the
hospital pharmacist. The patient was discharged on day 21, and was to have the IV therapy
continued.
The HHS pharmacist was to dispense the medications and a nurse for the HHS was to
administer the medication. After the completion of a laboratory test to monitor the patient status,
the HHS pharmacist noted a change, and reported the information to the physician. The
physician made adjustments to the dosage.
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The HHS pharmacist noted that the patients creatinine levels should be tested, and
informed the physician. The physician did not take the suggestion for action, and did not
respond to the pharmacist. Neither the patient nor the HHS nurses reported any new symptoms
or problems that would indicate the need to follow up further on the creatinine test. The
pharmacist did not pursue the matter further.
Sorting the Data
The major parties involved are the HHS pharmacist (defendant), the patient (plaintiff),
and the physician. The important facts are that the patient developed a rash, was treated by the
physician, was admitted to the hospital and further treated with Vancomycin and Gentamicin.
The patient was sent home with orders to continue the Vancomycin and Gentamicin therapy to
be filled by the HHS pharmacist, administered by a HHS nurse. Lab tests indicated that the
dosage needed to be changed, and the change was made. The HHS pharmacist noted the need
for a lab test, and the physician did not act on the suggestion. The patient did not complain of
any new problems during the treatment.
There has been no outcome of the patients care documented. No harm has been indicated
in the case. A comprehensive list of all medications was not given. The results of the laboratory
tests were not included nor the reason other than monitoring for the creatinine test. There was no
information on why the physician choose not to order a creatinine test. Without any of this data
the rest of the facts are unimportant.
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Examination of the data
The pharmacist acted in a reasonable manner about the creatinine since the patient did not
report any new symptoms. Up to the point where the physician choose not the respond to the
creatinine test suggestion their actions seemed justified. I see no implications that there was a
HIPPA violation. If the HHS has contracted with the patient for case management, the labs will
be ordered by the physician and the sample most likely collected by the nurse and resulted back
to the HHS, and later reported to the physician. There was no release of patient information. If
the patient was harmed, and there is a judgment for the plaintiff a change in the standard of care
for home health services, case management and/or physician follow up could occur.
Arguments/Legal Issues and Conclusion
First and foremost I would issue a demurrer, and ask for a bill of particulars. There was
no establishment of harm on the part of the pharmacist. The pharmacist did report the need to
monitor the creatinine level to the physician, and the physician did not act. The least persuasive
argument would be the expectation of the pharmacist to constantly follow up with a physician if
they disagree with a diagnostic action. If the matter was related to possible harmful dosages of
medication that would be a different matter. The strongest argument is that a pharmacist cannot
order a lab tests or interpret them. Those actions require a provider’s order and viewing. If the
physician did not act after the pharmacist’s note they have failed to care for the patient, not the
pharmacist.
Who is responsible for the outcome of a patient’s treatment if the physician fails to act?
Can you establish failure to monitor if there is no harm? What is the proper documentation or
amount of follow up required from a pharmacist to a physician?
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References
None.