Reference no: EM133710097

Question

Maitland Hospital is a major tertiary hospital located 32 kilometres from the city with 498 beds and provides specialist healthcare to the surrounding township of Maitland and Northfield. The evening shift has just commenced, with registered nurse (RN) Galop accepting the role of the triage nurse, as she has worked in the hospital for the past 11 years. Although it is a Thursday evening, it is hectic as two nurses and a registrar have called in sick. The after-hours nurse unit manager stated that he could not replace the three absent staff members and requested the shift coordinator to allocate additional beds to the current staff. The Emergency Department (ED) waiting room is filling quickly, and RN Galop feels overwhelmed as she usually works in the orthopaedic ward and is unsure who to contact for additional support.

At 2137 hours, Mrs Sharp presents with her 4-month-old infant, Daniel, who has a 3-day history of gastroenteritis. Using the Children's Early Warning Tool (CEWT), RN Galop examines Daniel and assesses that he is alert, slightly tachycardic (172 b/min), respiration rate is 42 breaths per minute, oxygen saturation is at 98% on room air, temperature of 38.1 degrees Celsius and scoring a total of four on the CEWT. Registered nurse Galop triages the infant as a 'mildly urgent' case and directs Mrs Sharp back to the waiting room to await further consultation as the intern is busy. During the consult, Mrs Sharp outlined that Daniel is still breastfeeding regularly and has had multiple nappy changes throughout the day.

At 2155 hours, RN Fantle, a recent graduate RN with no ED experience, is sent from the Cardiac Ward to relieve RN Galop so she can assist in the airway management of a patient brought in by ambulance. A brief handover was provided in the resuscitation area. Registered nurse Fantle sees Daniel asleep in his mother's arms and does not want to disturb the infant. Mrs Sharp indicates to RN Fantle that she believes Daniel is getting worse. Registered nurse Fantle tells Mrs Sharp that it "should not be too long now before a doctor can review your baby" and proceeds back to the triage office.

At 2218 hours, as RN Galop returns to triage, Mrs Sharp rushes to the desk, saying she cannot wake Daniel up. A MET call is initiated, and Daniel is transferred to the resuscitation bay. Daniel was successfully resuscitated; however, required intubation and spent three weeks in the Paediatric Intensive Care Unit. Unfortunately, Daniel experienced a brain injury due to hypoxia and was subsequently diagnosed with hypoxic-ischemic encephalopathy. The paediatrician advised Mrs Sharp that Daniel will experience developmental delays and the brain injury may cause cerebral palsy, which will require additional support for the remainder of his life.

1. Discuss the issues in the above scenario with reference to the four elements of the tort of negligence. Did the RNs breach their duty of care towards Daniel? Why/why not?