Ally is a 17 year old female with a two year history of Crohn’s Disease, and currently studying Year 12

Ally is a 17 year old female with a two year history of Crohn’s Disease, and currently studying Year 12

Ally is a 17 year old female with a two year history of Crohn’s Disease, and currently studying Year 12. Ally arrived for admission to the Day Surgery Unit (DSU) at Lakewood Drive Medical Centre for a routine colonoscopy and biopsy scheduled for theatre at approximately 10.00 hrs.

Ally was admitted to the DSU by the registered nurse (RN), Sharon. The consent was checked as part of the procedure, and Sharon noted that consent had been given by Ally’s father for colonoscopy and biopsy. Ally’s vital signs were recorded as: temperature: 37.2; pulse: 70 bpm; respirations: 16bpm; and blood pressure 110/75 mmHg.

Ally was transferred to theatre for the procedure at midday because an emergency surgical case earlier in the morning caused a significant delay for all elective procedures. Following the colonoscopy, Ally returned to the DSU ward at 1400hrs. Her condition was haemodynamically stable and she was fully conscious although complaining of mild abdominal pain (pain score 3/10). She also said she felt she was ‘leaking slightly’ from the bowel and thought it might be some diarrhoea. Routine (half hourly) observations were commenced.

The shift was chaotic due to the earlier disruption to the surgical list, and at 1450 hrs, Sharon realised that Ally’s observations were behind schedule. She quickly took Ally’s pulse and noted it was slightly tachycardic. She estimated the pulse rate as 108 and also noted some tachypnoea but did not chart this observation. Ally’s blood pressure was slightly lower than on admission at 90/50 mmHg and the abdominal pain had increased (pain score 7/10). She also stated she felt slightly light headed but Sharon suggested it was probably due to the fasting and bowel preparation (liquids only for 24 hours).

Sharon quickly handed over to the afternoon staff at 1500 hrs and was happy to go home after such a busy and stressful shift. At home, Sharon posted to her friends on social media her reflections of the day – she sarcastically ‘thanked’ Mr Jones, the surgeon, for giving her another miserable shift, and ‘thanked’ her 17 year old patient for whining about her abdominal pain after a simple colonoscopy procedure.

In the meantime, RN Joe took over Ally’s care and quickly noted that she had significant PR bleeding evident, increasing abdominal distension and her pain score had increased to 10/10. Her vital signs had also deteriorated. Joe told Ally that he had to notify the doctor immediately because she was bleeding, and in accordance with NSQHS ‘Standard 9,’ initiated a Medical Emergency Team (MET) call.

The attending team made the decision to take Ally back to theatre for an emergency ‘colonoscopy/laparoscopy +/- an open laparotomy.’ Ally’s dad (her mother died when she was seven) was uncontactable by phone. Ally was frightened and immediately

gave her own verbal and written consent for the surgery once the situation had been explained by the doctors.

Following complicated surgery where Ally had a partial colectomy for a perforated colon, she returned to the ward. The next day her vital signs were within an acceptable range and despite feeling tired and sluggish, she was slowly recovering.

One of Ally’s friends shared Sharon’s Facebook post with Ally and told her that the surgeon wasn’t very good and had a history of medical errors. Ally was furious and told the unit manager she was going to discharge herself, despite being advised that she needed several more days in hospital for pain relief, IV antibiotic therapy and wound manage




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