A charge nurse observes a client fall while ambulating with an assistive personnel and notes that the client's gait belt was not in place. When reviewing the incident report, the charge nurse finds that the report does not mention the gait belt. Which of the following ethical principles should the charge nurse follow?

The correct answer is: d.

Choice A reason: An allergy to penicillin requiring an alternative antibiotic to be prescribed is a common and expected variation in care. Allergies are patient-specific factors that must be accommodated within the care pathway. The need for an alternative antibiotic does not typically constitute a variance that requires reporting, as adjustments for allergies are part of personalized care planning.

Choice B reason: Initiating antibiotic therapy 2 hours after implementation of the care pathway may not require a variance report if it falls within the acceptable time frame for antibiotic administration. The timing of antibiotic therapy can be critical, but slight deviations are often accounted for within the care pathway guidelines. However, if the care pathway specifies a narrower time frame for initiation, then this could be a reportable variance.

Choice C reason: Changing the route of antibiotic therapy from IV to PO (oral) is a clinical decision that may be based on the patient's condition, progress, and ability to tolerate oral medications. This switch is a part of antimicrobial stewardship and is often encouraged when clinically appropriate to reduce IV line use and potential complications. It is a standard practice and does not typically require a variance report unless the change contradicts a specific protocol in the care pathway.

Choice D reason: Obtaining a blood culture after the initiation of antibiotic therapy is a significant variance from the standard care pathway. Blood cultures should be obtained before starting antibiotics to accurately identify the causative organisms and their antibiotic sensitivities. Starting antibiotics before obtaining blood cultures can reduce the likelihood of growing the bacteria in the culture, potentially leading to misdiagnosis and inappropriate treatment. This is a deviation from the standard of care that requires a variance report.

Choice A reason: The client's electrical cord is taped to the floor is not a safety hazard, but rather a safety measure to prevent tripping or pulling the cord.

Choice B reason: The client's bedside lamp is plugged in using an extension cord with two prongs is a safety hazard because it poses a risk of fire or electric shock. Extension cords should have three prongs and should not be used for permanent wiring.

Choice C reason: The client has used tacks to secure the carpet on the stairs is not a safety hazard, but rather a safety measure to prevent slipping or falling on the stairs.

Choice D reason: The client stores cleaning supplies in a locked cabinet above his head is not a safety hazard, but rather a safety measure to prevent accidental ingestion or exposure to toxic substances.