STROKE MEDICAL NEGLIGENCE INADEQUATE MONITORING OF STROKE PATIENTS  

John Whelan Solicitor with specialist expertise in Stroke Medical Negligence gives an example of inadequate monitoring of Stroke where the failure led to delays in treatment and worsened the Patient's outcome.

An example of a case involving inadequate monitoring of a stroke Patient, which led to serious complications:

Case Example: Inadequate Monitoring of a Stroke Patient

A Patient is admitted to hospital after suffering a mild ischemic stroke affecting the left side of the brain, leading to some weakness in the right arm and mild speech difficulties (aphasia).   The Patient arrives at the hospital within three hours of symptom onset and receives tPA (tissue plasminogen activator) to dissolve the clot.

Initial Hospitalisation:

a) After tPA administration, the Patient is admitted to the stroke unit for observation and recovery. The Patients vital signs are stable, and the Patients symptoms begin to improve within the first few hours.

b) Standard stroke protocol: Post tPA Patients should be closely monitored for signs of complications, especially bleeding in the brain (intracerebral haemorrhage), which is a known risk after thrombolytic therapy. This requires frequent neurological checks, blood pressure monitoring, and symptom tracking for the first 24 hours.

Inadequate Monitoring:

1. Staff Shortage: The stroke unit is understaffed on the night shift, and the Patient does not receive the recommended frequent neurological assessments (typically every 15 minutes for the first 2 hours, then every 30 minutes for the next 6 hours, and then every hour thereafter). Instead, the assessments are spaced every few hours.
2. Blood Pressure Not Properly Controlled: The Patients blood pressure, which should be tightly monitored and controlled post tPA, fluctuates during the night.    The Patient’s Blood Pressure rises and this increases the risk of bleeding, but this goes unnoticed because the blood pressure is not being checked frequently enough.
3. Signs of Deterioration Ignored: The Patient begins to experience worsening headache and confusion but these symptoms are not immediately addressed. A nurse briefly notes the Patient’s complaint of a headache in the chart but attributes it to post stroke fatigue.

Missed Opportunity for Early Intervention:

a) Later the Patient becomes unresponsive, and the nurse calls for an emergency evaluation. A CT scan is ordered, which reveals a large intracerebral haemorrhage bleeding in the brain, a known complication of tPA.

b) Unfortunately, because the signs of deterioration were not acted upon quickly, the Patient’s condition has worsened significantly. He is transferred to the intensive care unit (ICU), but the bleeding has caused severe brain damage.

Outcome:

The Patient suffers permanent left sided paralysis (hemiplegia) and a decline in cognitive function due to the brain bleed. His prognosis is poor, and he is left with significant physical and mental impairments that could have been mitigated with timely intervention.

Important Points of the Case:

1. Inadequate Neurological Monitoring.
2. Blood Pressure Management.
3. Failure to Act on Symptoms.

For more detailed insights into how Stroke Medical Negligence and Patient Safety impacts you and how Whelan Law can support you, please visit our Patient Safety Rights Legal Advice https://www.whelanlaw.ie/news/stroke-medical-negligence-claims-what-you-need-to-know/