Matters of judgment

Activity summary

The following scenario illustrates a situation in which a patient experienced a complication during care. The facilitation questions are focused on helping learners understand that adverse outcomes may be a consequence of a harmful incident (accident in Québec) an inherent risk of a medical procedure, or the underlying medical condition/disease.

Scenario

A 61-year-old female artist falls and sustains an injury to her right wrist (dominant hand). The clinical exam is consistent with a Colles fracture that is confirmed on X-ray. A closed reduction and immobilization is performed using procedural sedation. Post-reduction X-rays, taken through a properly applied cast, show a near anatomical reduction.

The patient is discharged with instructions to follow up with an orthopaedic surgeon in 1 week. Six weeks later the cast is removed and X-rays confirm appropriate bone alignment and callus formation at the fracture site.

Despite this evidence of healing, the patient notes severe burning pain in the forearm, hyperalgesia, and intermittent changes in skin colour. A diagnosis of chronic regional pain syndrome is made, and the patient is referred to a chronic pain specialist. The condition proves unresponsive to a variety of medications and nerve blocks. The patient is unable to resume her artistic endeavours.

Is this a harmful incident (accident in Québec)? Why?

Is what happened related to the medical condition, an inherent risk of the reduction and casting treatment, a system failure, or an issue of provider performance? Discuss.

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