 Activity 1

 Case study

o You are part of a nutrition support team consulting service, which is lead by a
physician and pharmacist. To be confident for your team presentations on round
you decide to make pre-rounds on all patients. You visit each patient and review all
charts. Upon initial review of one patients chart, you notice that the nutrition
support orders determined on the previous days that week were never documented
and therefore not given to the patient. When you approach the RN, she says the
orders were never changed and therefore you must take it up with the team
leadership. Lacking the confidence to directly approach the MD or pharmacists you
decide to:
 Ignore the mistake and not approach your colleagues regarding the error to avoid an
unpleasant encounter on rounds. After sharing the story with the clinical nutrition manager,
she advises you to let it go as it will upset the team dynamics and our position should be to
avoid any type of confrontation.
 Not address the impact of the failure to provide the prescribed care to the patient that was
appropriate and accept the mistake as common and with minimal impact on the patients’
outcome.

o Questions for Discussion:

 Is there sufficient information to make a decision?
 Is the situation an ethical issue? Or, is it a business dispute?
 What are the issues of concern in the case study presented?
 What principle(s) of the Code of Ethics does it relate and how/why?
 What could be done to resolve this situation without bring a complaint forward?

 There is sufficient information to recognize that there was a failure in providing prescribed
care to the patient, as the nutrition support orders were not documented and administered.

 This situation is primarily an ethical issue as it involves the patient's well-being and the duty
of healthcare professionals to provide appropriate care. However, it can also be seen as a
professional responsibility and teamwork issue.

 The main issues of concern in the case study include:

 Patient safety and well-being: The patient did not receive the prescribed nutrition support,
potentially impacting their recovery and outcome.
 Communication and teamwork: There appears to be a lack of communication and
accountability among team members, leading to the oversight.
 Ethical responsibility: Healthcare professionals have an ethical obligation to provide the best
possible care to patients, which includes ensuring that prescribed treatments are
administered.
  This situation relates to principles of the Code of Ethics such as beneficence (acting in the
best interest of the patient), accountability (taking responsibility for one's actions), and
professionalism (maintaining standards of professional conduct).

 To resolve this situation without directly confronting colleagues, one could consider the
following steps:

 Discuss the issue with the clinical nutrition manager or another neutral party who can offer
guidance on how to address the situation effectively and professionally.
 Initiate a team meeting to discuss the importance of documentation and adherence to
prescribed treatments, without singling out individuals.
 Implement measures to improve communication and documentation processes within the
team to prevent similar errors in the future.
 Offer additional training or education on nutrition support protocols to ensure all team
members are knowledgeable and confident in their roles.
 Emphasize a culture of accountability and transparency within the team, where mistakes can
be acknowledged and addressed constructively for the benefit of patient care.

As a member of the nutrition support team, the situation you've encountered is indeed challenging
and requires careful consideration. Let's delve into the questions for discussion:

### Is there sufficient information to make a decision?

From the scenario you've described, there are some clear points:

- Nutrition support orders were determined for a patient.

- These orders were not documented or given to the patient.

- The RN claims the orders were not changed.

- The clinical nutrition manager advised you to let it go to avoid confrontation.

While there is a basic outline of what happened, there might be missing details:

- Why were the orders not documented?

- Were they communicated verbally but not written down?

- Was there a misunderstanding between the team members?

Without these details, it might be challenging to fully understand the situation.

### Is the situation an ethical issue? Or, is it a business dispute?

This situation can be seen from both ethical and professional perspectives:

- **Ethical Issue**: Patient care is at the heart of healthcare, and any failure to provide prescribed
care can be seen as an ethical concern. The patient's well-being is paramount, and if they did not
receive the prescribed nutrition support, it could impact their recovery and outcomes.

- **Professional Issue**: There is a professional responsibility among healthcare team members to

communicate effectively, document care accurately, and ensure patients receive the prescribed
treatment. This can be seen as a breakdown in teamwork and communication.

### What are the issues of concern in the case study presented?

Several concerns arise from this case study:

- **Patient Safety**: The foremost concern is the impact on the patient. They did not receive the
nutrition support prescribed, which could affect their recovery.

- **Communication**: There seems to be a breakdown in communication between team members.

Orders were not documented or implemented, leading to confusion.

- **Team Dynamics**: There is a fear of confrontation or upsetting team dynamics, which can hinder
open communication and resolution of issues.

### What principle(s) of the Code of Ethics does it relate to and how/why?

The situation touches upon several principles of medical ethics:

- **Beneficence**: The principle of doing good for the patient is relevant here. It is the duty of
healthcare providers to ensure patients receive the care they need for their well-being.

- **Non-Maleficence**: This principle relates to the duty to do no harm. By not providing the
prescribed nutrition support, harm could potentially come to the patient.

- **Veracity**: This principle involves truthfulness. There might be a lack of transparency in the
situation if orders were not properly documented or communicated.

### What could be done to resolve this situation without bringing a complaint forward?
Here are some steps that could be taken to address the issue:

- **Clarification**: Speak with the RN to understand why the orders were not documented. There
might be a misunderstanding or miscommunication.

- **Team Discussion**: Bring up the issue in a team meeting, focusing on improving communication
and ensuring all orders are documented.

- **Education**: Offer education sessions on the importance of accurate documentation and

communication in patient care.

- **Quality Improvement**: Use this incident as an opportunity for quality improvement, such as
implementing a system to track and ensure all orders are followed through.

It's essential to approach this situation with a focus on patient care and improving team dynamics,
rather than assigning blame. It might also be helpful to seek guidance from the clinical nutrition
manager or other senior members of the team for their input on resolving the issue. Ultimately, the
goal should be to prevent similar incidents in the future and ensure the best care for the patient.