Case 3 - Patient Safety 25W

  • Admission to hospital

    Admission to hospital
    1. Admitted due to 3 weeks of increased shortness of breath and cough.
    2. DX = acute COPD exacerbation and failure to cope.
    3. Treated with antibiotics and steroids.
  • Geriatrics and Palliative Care Consult

    Geriatrics and Palliative Care Consult
    1. Geriatrics identified mild-moderate Dementia/Alzheimer’s disease.
    2. Geriatrics suggested palliative care consult.
    3. Palliative care determined the patient was not appropriate for Hospice at this time.
    Goals of care discussed with Patient:
    - Comfort
    - Quality over quantity of life.
  • Transfer to Complex Care

    Transfer to Complex Care
    Patient transferred to complex care while awaiting placement in LTC.
  • Fall Incident

    Fall Incident
    • 01:35 → Bed alarm sounded; patient found on the floor, confused, and searching for his friend “Archie.” Complained of left elbow pain.
    • 05:45 → Patient reported pain in buttocks; bruise noted on the right hip. Pain medication administered.
    • 08:00 → Doctor notified of the fall.
  • Post Fall Assessment

    Post Fall Assessment
    • Imaging → Bilateral hip and pelvic x-rays ordered, showing suspicion of pubic fracture. CT scan later confirmed comminuted fractures of the right and left pubic inferior ramus.
    • Orthopedics Consult → Assessed the patient with the POA (niece) present. Decided the patient was not a surgical candidate and ordered weight-bearing as tolerated.
  • Post Fall Evolution

    Post Fall Evolution
    • Patient’s mobility significantly declined; staff used a Sam Hall Turner with difficulty.
    • Patient primarily stayed in bed and consumed minimal fluids.
  • Palliative Care Initiation

    Palliative Care Initiation
    • Patient’s condition continued to decline.
    • Nurse Practitioner discussed palliative care with the POA; palliative care order set initiated.
    • Family declined Hospice transfer.
  • Patient Passed Away

    Patient Passed Away
    Patient passed away in the hospital.
  • Credits

    All images were AI generated by @DelgadoHD using Dall-E, Designer Bonkers prompts.