Problem: Illegal or unethical?
Pt Blocking fall is a newly admitted patient with end stage renal disease (ESRD). The RCP is paged to the room because the patient is beginning to desaturate and has some moderate increased WOB along with anxiety. The patient family is at the bedside and really involved in the patient's care.
The MD was paged to modify the order regarding sedation because of the patient's increased agitation.
MD has not responded after 30 minutes or so and the RCP is still at the bedside.
During the ride on elevator to the patient's room the resident (senior MD) is discussing the case with his intern (junior physician) stating Mr. Blocking fall condition is deteriorating and family is being stubborn regarding his code status. The physician continues to say the wife is trying to keep him alive for the next check which is scheduled to arrive on the 15th.
Meanwhile, at the bedside patient has a deviated trachea (from the mid-line potion) in addition to fine crackles on the right side with no breath sounds on the left side. Saturations are 91% while the patient is on room air.
The RCP and the rest of team discuss the treatment plan at the bedside contemplating the plan of care. Further complicating the issue, the patient requested not to be intubated. The family and more specifically the daughter is persistent about keeping him alive and eventually having the patient trached.
1. Utilizing the SOAP notes method explain each part (Ie, what is the S, O etc.)
2. Based on the initial assessment what is your treatment plan?
3. What violations if any of HIPAA are occurring on the elevator?
4. What violations if any of HIPPA are occurring at the bedside?
5. What ethical or legal issues are evident in the scenario and what should be the course of action for the entire medical team?