Monday, May 16, 2011


Dr. Kathy Van Klein, the new chief medical officer at Belleville Hospital, studied the report on the medical chart. Somebody had given the patient in the labor room a pre-term IV drip of 52 gms of magnesium sulfate to stop contractions when 2 gms should have been administered over four hours. Fortunately, Kelly Ward RN happened to pass by and noticed that the patient was nauseous and alerted the physician.

Kathy and floor nursing supervisor, Don Crouch, stood near the nurse’s station trying to determine how the infusion could have been given at such an accelerated rate, and who had done it. They’d decided to handle it themselves and prevent it from ever happening again.

Don looked through the records on the physician’s order for the patient and finally found it. He looked it over and showed it to Kathy. The 2 gms of magnesium sulfate had been altered to read like a “3”.

Kathy checked with the physician and learned that he had indeed prescribed only 2 gms. “We need floor staff’s activities this morning – duties, times when those duties were performed, and records,” she said to Don.

Don produced the list of nursing staff who were on duty and Kathy scrutinized it. Kelly had been assigned to a patient who was soon due for delivery. Jodie McKinley, the orientee nurse had come in at seven and evaluated the new baby with a mild case of jaundice before getting the IV going on the patient.

“Any special duties and assignments?” Kathy asked.

Don glanced at a chart in his hand. “While Kelly Ward was assisting in the delivery she was called to ER briefly. Evelyn Hyrkas was in C-section as assigned.”

Kathy looked up from the list. “What about you? Where were you?”

“I was helping out with a pre-eclampsia case down the hall.”

“Who was here at the nurse’s station?”

“A couple of nurses checking over schedules, but they were not assigned to this patient and would have no reason to be with her.” Don shuffled through papers lying on his desk.

“Call in Kelly, Jodie, and Evelyn, and we’ll go from there.” Kathy went into Don’s glass-enclosed cubicle behind the nurses’ station. It was lunchtime and things were slowing down. Newly hired aides helped incoming nursing staff in their mid-day duties.

Kelly said she had come in at seven and had gone straight to the delivery room and had been there until another nurse relieved her. When she passed the labor room at eight-twenty, she had noticed the patient looking sick and called the physician.

“Where was Jodie?” Kathy asked.

Kelly shrugged. “I don’t know.”

“Had you met the orientee nurse before?”

“No. She hasn’t been here before.”

When they questioned Evelyn she told them she had been at the C-section. After that she had gone to monitor the vital signs of two other delivery patients. She had also stopped by the nurses’ station to check the afternoon schedule.

“Did you see anyone at the nurse’ station?” Kathy asked.

“No. It was deserted,” Evelyn replied.

“What time was that?”

“About ten after eight.”

When they were done with Evelyn, Jodie, the orientee nurse, was called in. She was in her late thirties. Her employee file, which Don had pulled earlier, indicated that she had put herself through nursing school and showed promise. Quite the hard worker, he noted.

“What were your duties when you came in?” Kathy asked.

“After checking in with HR, I was brought to the nurses’ station and Don gave me my schedule. When I was finished at the nursery I set up the IV for magnesium sulfate and started the infusion as prescribed,” Jodie said. She had a intense look about her, like the type who’d do whatever was necessary to get ahead.

“Were you with the patient most of the time?” Kathy asked.

“Yes. Oh - I was called to the phone at the nurses’ station, but when I got there I found there was no one on the line,” Jodie replied.

“It’s quite a long walk from the labor room to here,” Don remarked.

“Who told you about the phone call?” Kathy asked.

“Brenda, an aide.”

After Jodie left, Kathy and Don went through Jodie’s employee file. Some of her records were under the last name of Hyrkas. She had been married to a Dave Hrykas.

Don paged Brenda, the aide, and she came in looking worried.

“You were the one who told the orientee nurse that she had a phone call?”

Lines furrowed deep in her forehead. “Yes. Is anything wrong?”

“Yes. There was a problem,” Don said. “Did you pick up the phone at the nurses’ station when it rang?”

Brenda looked puzzled. “Actually, Evelyn asked me to tell the orientee nurse about the phone call. I didn’t pick up the phone at all.”

Don then called the hospital switchboard and inquired if there had been any phone calls for orientee nurse Jodie McKinley in the maternity ward between eight and nine o’clock that morning. No, the switchboard operator told him, there hadn’t. She’d remember because that was a new name.

“The name ‘Hyrkas’ seems to be the link,” Kathy said. “Can you pull Evelyn’s file?”

Don had HR send down the file and Kathy studied it. Evelyn had been on the staff of Belleville Hospital for many years. She had two sons, the older one was in his mid-thirties, Don now remembered. This son had been through a nasty divorce several years earlier and it had devastated Evelyn. He was an accountant and his ex had taken him for all he was worth.

“I think we have our culprit,” Don said.

Kathy looked at him questioningly.

Don put down the file folder. “Evelyn changed the numbers. It’s time to have a talk with her.”

He reached for the phone, paged Evelyn, and then waited.


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