Linda Stevens, LPN, works on a medical floor at the local hospital. One of the patients she has been assigned to take care of is Frank Gibbons, a 72-year-old newly diagnosed with diabetes (a condition in which the body does not produce enough insulin to control blood sugar levels). Part of Linda’s process of preparing to care for her patients is to review the patients’ charts for any new physician orders. She notes that Dr. Romero was in the previous evening and ordered the patient’s blood sugar to be checked at 8 a.m. According to the results, insulin is to be given. (The higher the level of blood sugar, the greater the amount of insulin that is given, based on a formula defined by the physician.) Linda is a “thinking nurse” and starts to question if this is an appropriate order. She realizes that breakfast trays arrive at 7:30 a.m. on her floor and that Mr. Gibbons will already have eaten when she checks his insulin level at 8 a.m. She knows that after eating, a person’s blood sugar normally increases for a few hours. This is why blood sugar tests are usually ordered when the patient has not eaten for a number of hours. Linda reasons that if she calculates the amount of insulin based on the temporarily elevated blood sugar levels, Mr. Gibbons will receive too much insulin and may have a negative reaction. Linda calls Dr. Romero to clarify the order. Dr. Romero states that he believed the breakfast trays did not arrive until 8:30 a.m. He thanks Linda for catching the error and changes the order.

• What might have happened if Linda had simply performed the blood sugar test exactly as ordered?
• Do you think Linda should have been considered responsible for the error if she had followed the orders exactly?
• Review the five Ws and How questions in relation to this situation. Give examples of questions that Linda may have asked herself.