The Lewis Blackman Story: A
Comprehensive Case Study on Patient
Safety and Healthcare Improvements
( updated) 2024 2025 guide
Why does Helen Haskell start her story by talking about Lewis?
She wanted people to know who her son was. By portraying him as someone who had value and life that
was unnecessarily lost, we are able to understand her loss.
What is Ketorolac (indications, side effects, normal dosages for 15 year old,)?
Ketorolac is a pain medication (NSAID). This is used for moderate/severe pain. This medication can cause
GI bleeds, oliguria, renal toxicity and N/D. For a 15 yr old he should be receiving 1mg/kg IM for a max of
30mg or 0.5mg/kg IV for a max of 15mg. He received an adult dose with a peds rate of IV fluids.
What was the significance of lack of urine output (to underlying problem, amount of Ketorolac,
and need for fluids)?
Ketorolac is contraindicated in pts with dehydration, low blood volume, or kidney disease. Ketorolac can
also cause kidney failure however low urine output is a side effect. Lewis was receiving a pediatric rate
of IV fluids but received an adult dose of ketorolac. This resulted in dehydration which increased the risk
of side effects.
What are possible reasons why health care providers dismissed implications of undetectable
blood pressure? Why would they think it was equipment failure?
The health care providers might have been blind to the possibility that these complications could occur
to someone that appears to be a healthy 15 yr old. By overlooking certain complications like not being
able to find a blood pressure this demonstrated how the health care providers did not believe the
complication was presenting.
,Do you agree that it was significant that Lewis's crises developed on the weekend? Explain why
or why not.
There could be the possibility of a decreased amount of staff on hand. Possibly doctors do not want to
be notified unnecessarily. Regardless of the timing, someone could have recognized Lewis's situation for
what it was and acted on it.
Lewis died from septic shock. Describe the incidence, signs/symptoms, and appropriate
interventions for this problem.
Septic shock presents as low BP, increased temp, low urine output, tachycardia, agitation/restlessness,
lethargy, confusion and can result in death. IV antibiotics, vasopressors and insulin should be used as
required to treat these symptoms and maintain stability.
Create a list of the characteristics Helen Haskell ascribes to a "good" or professional
nurse/physician.
Adequate training and ability to act in emergent situations
Patient advocate
Awareness of medications and side effects
Critical thinking skills
Patient teaching
When Helen Haskell says "patients need to be empowered and nurses need to embrace it", how
do you react to her suggestion?
Patients should be included in their care and nurses should help them fully address their concerns and
questions. Helping patients in this way will allow them to be aware of their condition and will enable
them to speak up about their care.
, What does Helen Haskell mean by "misplaced professionalism"?
If a nurse believes that they know better/more than the patient, the nurse becomes an obstruction to
that patients care. They do this by not listening or not knowing how to react.
In her story, did you think of other examples of "misplaced professionalism"?
I have seen nurses dismiss a patients questions or concerns before. But I have also seen nurses react
positively to the patients concerns by addressing them seriously.
What is professionalism in your view?
Professionalism is a combo of qualities and traits that nurses use to guide their actions. This can be
through compassion, honesty, show of dignity, education, advocacy.
What is your reaction to Helen Haskell's view that nurses need policy-level help to be empowered with
respect to communications with physicians?
This will help nurses who have difficulty addressing authority or advocating for the patient. By requiring
nurses to give the physicians number this helps empower the families as well.
What factors in this hospital's "teamwork" culture might have contributed to the lack of response to
Lewis's parents' concerns?
Factors that contributed to the lack of response would be the fact that the concerns voiced by the
parents were ignored or brushed off. Other factors were that the parents were not able to communicate
with other team members as well as the fact that all of this happening on a weekend could lead to a
limited access to personnel.
Why does Helen Haskell start her story by talking about Lewis?
She wanted people to know who her son was. By portraying him as someone who had value and life that
was unnecessarily lost, we are able to understand her loss.
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