Delayed Diagnosis of Stroke: Case Review for Advanced Practice Clinicians
In reviewing closed malpractice claims, The Doctors Company identified diagnostic failure as a reoccurring problem and one of the top three leading allegations that result in malpractice claims. This failure often leads to a delay in treatment and causes significant harm to patients. The following highlights the importance of recognizing the signs and symptoms of a stroke. Factors contributing to delay diagnosis and treatment included failure to recognize the window (“last known well time”) for tissue plasminogen activator-clot buster (tPA) failure to order a stat MRI and neurology consult, failed communication among providers regarding changes of recurring symptoms of ischemic stroke, failure to appreciate new signs and symptoms of a stroke, and poor or inconsistent documentation. The National Academy of Medicine (NAM) has identified the top three causes of serious harm from diagnostic failure. Number one is ischemic stroke.
|Course ID #:||APE 221125.0||Issue Date:||8/4/2022||Expiration Date:||8/4/2025|
Description of the Professional Practice Gap (PPG)
In reviewing closed malpractice claims, The Doctors Company identified diagnostic failure as a reoccurring problem and one of the top three leading allegations that result in malpractice claims. This failure often leads to a delay in treatment and causes significant harm to patients.
Learners demonstrate application of knowledge and skills related to a patient at high risk for Stroke by answering four questions that follow the Case Study correctly.
After completing this activity, learners will be able to:
- Calculate the last known well time and identify the window for administration of tPA (3-4.5 hours of stroke onset).
- Conduct an accurate and thorough review of chief complaints and a neurological examination, and thoroughly document findings.
- Demonstrate enhanced communication and coordination among multiple providers.
- Evaluate when an urgent/emergent action is required such as a neurology consultation, stroke code or order for an MRI.
- Identify at least two strategies that can reduce the risk for a malpractice claim involving the failure to timely diagnosis and treat a stroke.
Kimberly Hathaway, MSN, RN, CPHRM, CPHQ, Director Patient Safety Healthcare Quality & Risk Management, The Doctors Company
Kathrine Soulsby, BSN, RN, Senior Patient Safety Analyst, Department of Patient Safety and Risk Management, The Doctors Company
Johanna Lackner, MPH, MSW, Senior Director, Continuing Professional Development, Department of Patient Safety and Risk Management, The Doctors Company
Accreditation and Disclosure Statements
The Doctors Company is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
The Doctors Company designates this activity for a maximum of 0.5 nursing contact hour. Learners should claim only the credit commensurate with the extent of their participation in the activity.
No individual in a position to control or influence the content of this activity has reported relevant financial relationships with commercial interests. No commercial support was provided for this activity.
This program is being offered for informational and educational purposes only from a Patient Safety Risk Management perspective and does not constitute legal advice. Laws vary from state to state, actual clinical situations often involve subtle differences and nuances from program scenarios or recommendations, and the recommendations provided in this activity may not apply to all practice situations. In complex circumstances, which present significant potential for an adverse event or litigation, TDC and the faculty recommend you consult directly with your corporate or personal counsel for professional legal guidance.
Complies with the State Requirements
Please SEE the Registered Nurse and Licensed Practical Nurse CE Requirements by State.
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