The importance of being thorough

So this week was our last week of clinic and I had a great start to the week on Tuesday with three of my patients being invloved in an 'incident' with me or immediately after I had seen them. The first incicent was unavoidable so I wont go into that here. The second, however, could have been prevented or at least handled a lot better on my behalf.

I was told to take a patient to the exercise class we hold daily on the ward (medical specialties ward at RPH, cardio placement), with the intention of doing some leg exercises with him as he wasnt moving his legs very well and to get him to walk for some distance without his WZF. So with this in mind we walked to the class (roughly 70m) with the frame, doing some UL and LL exercies in the class with a focus on some active-assisted knee extension in sitting, then walking back to his room without the frame, just me putting it a few metres in front, then us both walking up to it. His knee collapsed about 40m into the walk back, so I gave him the frame and he happily walked on back to his room. When he was safely in his chair, ready for lunch, I left him, but not until I had questioned him on any pain/dizziness, which I had been doing throughourt the treatment.

I was informed later that day by a nurse that a short time later, on doing her routine obs, this patient was found to have a blood pressure reading of 85/35 and instruced to lay in bed with the head tilited down until this resolved. At this stage he was also looking out of sorts, and apparently feeling pretty crap, none of which was reported to me or present when I was with the patient. I felt pretty guilty at this stage and was thinking how this could have been avoided.

As it turned out, the reason this guy couldnt move his legs was because they had been burnt, quite serverly, so of course he was in a lot of pain and had restriced ROM which I should not have pushed as far as I did in the exercise class had I know. This was not presented to me in my 1 mintue handover of the patient, but I should have taken the time to read his notes, find out why he was in hospital and his current problems.

On top of this I should have checked his obs after the treatment. In my defence I had checked his chart before treatment, his obs were stable and there was no indication that he would have any adverse affect to the treatment. But this was the most amount of exercise he had done in a while and I really should have monitored him more closely and it was just lucky that his nurse did this for me!

I wont go into the third patient but lets just say it was a very draining day and one that reinforced to me the importance of being thorough with my monitoring of patients and keeping in mind other complicating factors/co-morbidities thart may impact on their treatment and how they will respond.