Nurses: Protect Yourself Against Medication Errors

Nurses face a busy schedule often including a long list of patients and extensive work hours. As a result, they can become overworked and overtired, which may lead to a higher risk of making a mistake when administering medication.

An Institute of Medicine (IOM) report titled To Err is Human: Building a Safer Health System (IOM, Dec. 1999) states the deaths from medication errors that take place both in and out of hospitals, more than 7,000 annually, exceed those from workplace injuries. In a separate report, investigation by the Chicago-Tribune states that since 1995, at least 1,720 hospital patients have died and 9,548 others have been injured because of mistakes made by RN’s across the country (Associated Press, Sept. 10, 2000).

Because nurses usually are the front-line health care providers who are required to administer medications prescribed by physicians, they must be especially careful in their procedures and practices to avoid one of the many types of common medication errors.

Common types of medication errors involve:

1. similar sounding medication name;

2. administration without a prescription;

3. the wrong medication;

4. the wrong dosage;

5. negligent injection;

6. failure to note an order change;

7. failure to administer medication;

8. failure to discontinue medication;

9. use of an unsterile needle;

10. the wrong patient;

11. allergic reactions; and

12. failure to assure patient taking medications.

Nurses are required to handle and administer a vast variety of drugs that are prescribed by physicians and dispensed by an organization’s pharmacy. Medications may range from aspirin to esoteric drugs that are administered through intravenous solutions. These medications must be administered in the prescribed manner and dose to prevent serious harm to patients. There are a variety of ways to ensure that, as a nurse, you are helping to prevent medication errors within your facility.

Use this checklist from George Indest’s Nursing Law Manual in order to maintain safe administration procedures. Nurses are exempted from the various pharmacy statutes when administering a medication on the oral or written order of a physician. However, the improper administration of medications can lead to malpractice suits.

ADMINISTRATION OF CONTROLLED MEDICATIONS WITHOUT A PRESCRIPTION

A nurse should never administer prescription medications without a valid prescription or order from a physician. In effect, doing that constitutes practicing medicine without a medical license and is beyond the scope of a nurse’s license. Administering medications without approval may give rise to legal liability and disciplinary action against the nurse.

ADMINISTERING THE WRONG MEDICATION

The injection of the wrong medication into a patient can lead to civil liability or to a charge of substandard nursing care made to the Department of Health. A nurse who prepares medication for a physician is liable for the preparation of that medication. A physician can blame a nurse who fails to prepare the medication properly in order to escape liability.

In the case of Ambercrombie v. Roof, a solution was prepared by a nurse employee and injected into the patient by a physician, 28 N.E. 2d 772 (Ohio 1940). The physician made no examination of the fluid, and the patient suffered permanent injuries as a result of the infection. An action was brought against the physician for malpractice. The patient claimed that the fluid injected into her was alcohol and that the physician should have recognized its distinctive odor. The court, in finding for the physician, stated that the physician was not responsible for the misuse of drugs prepared by the hospital, unless the ordinarily prudent use of his faculties would have prevented injury to the patient.

GIVING THE WRONG DOSAGE

A nurse is responsible for making an inquiry if there is uncertainty about the accuracy of a physician’s medication order in a patient’s record. A nurse who is in doubt about a physician’s orders should contact that physician and seek clarification of their order.

WRONG ROUTE

In Fleming v Baptist General Convention, 742 P.2d 1087 (Okla. 1987), a nurse negligently injected the patient with a solution of Talwin and Atarax subcutaneously, rather than intramuscularly. The patient suffered tissue necrosis as a result of the improper injection. The suit against the hospital was successful. On appeal, the court held that the jury’s verdict for the plaintiff found adequate support in the testimony of the plaintiff’s expert witness on the issues of nursing negligence and causation.

FAILURE TO NOTE AN ORDER CHANGE

A nurse’s failure to review a patient’s record before administering a medication, to ascertain whether an order has been modified, may render a nurse liable for negligence.

FAILURE TO ADMINISTER MEDICATION

In Kallenberg v. Beth Israel Hospital, 357 N.Y. S.2d 508 (N.Y. App. Div. 1974), a patient died after her third cerebral hemorrhage because of the failure of the physicians and staff to administer necessary medications. When the patient was admitted to the hospital, her physician determined that she should be given a ceratin drug to reduce her blood pressure and make her condition operable. For some unexplained reason, the drug was not administered. The patient’s blood pressure rose, and after a hemorrhage, she died.

The jury found the hospital and physicians negligent in failing to administer the drug and ruled that the negligence had caused the patient’s death. The appellate court found that the jury had sufficient evidence to decide that the negligent treatment had been the cause of the patient’s death.

FAILURE TO DISCONTINUE A MEDICATION

A health care organization will be held liable if a nurse continues to inject a solution into a patient after noticing its ill effects. Once something is observed to be wrong with the administration of the medication, the nurse has a duty to discontinue its use.

NONSTERILE NEEDLE

The blood donor in Brown v. Shannon West Texas Memorial Hospital, 222 S.W. 2d 248 (Tex. 1949), sought to recover from a serious injury allegedly caused by the use of a nonsterile needle. The court held that the burden of proof was on the plaintiff to show, by competent evidence, that the needle was contaminated when used and that it was the proximate cause of the alleged injury. The mere proof, said the court, that infection followed the use of the needle or that the infection possible could be attributed to the use of an unsterile needle was insufficient. If the plaintiff had been able to prove the needle was not sterile, then the plaintiff would have recovered damages.

WRONG PATIENT

It is of utmost importance to check each patient’s name bracelet before administering any medication. To ensure that the patient’s identity corresponds to the name on the patient’s bracelet, the nurse should address the patient by name when approaching the patient’s bedside to administer any medication. Especially in nursing homes and hospitals where there may be more than one patient in a room, this is exceptionally important. Should the nurse unwittingly administer one patient’s medication to a different patient, the attending physician should be notified and appropriate documentation placed on the patient’s chart.

ALLERGIC REACTIONS

Any adverse reactions to a medication should be charted on the patient’s medical record. The attending physician and the facility’s pharmacy should be advised as to the patient’s allergic reaction.

FAILURE TO MONITOR AND ENSURE PATIENT TAKING MEDICATIONS

A nurse normally has a duty to monitor and ensure that a patient is taking their medications. A failure to perform this act can lead to nursing negligence on the part of the nurse.

The nurse may be the last wall of defense to protect a patient from a medication error. Guard at every turn against medication errors. For more information about nursing law, or to read more from the Nursing Law Manual, visit www.TheHealthLawFirm.com.

The “Seven Rights” of Patient Medication

There is a checklist every nurse should learn called the “Seven Rights of Medication.” If this checklist is memorized and followed in every case, medication errors would be significantly reduced or eliminated altogether. Every nurse and nursing student should memorize this list and go through it in her mind every time a patient is administered a medication by the nurse. Always check for and confirm:

1. The right medication;

2. The right patient;

3. The right dose;

4. The right time;

5. The right route;

6. The right reason; and

7. The right documentation.

Adminstering medication is one of the major areas that an overworked nurse is at risk for making a mistake. Be sure to remember the items on this checklist, especially if you are feeling rushed. Taking an extra second to think everything through can save you from discplinary or legal action down the road.

For more information about nursing law, please visit our website at www.TheHealthLawFirm.com.

Nurses Fight for Lawmakers to Relax Laws Requiring Doctors to Oversee Their Work

CCS Blog LabelBy Carole C. Schriefer, R.N., J.D., The Health Law Firm and George F. Indest, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

There’s a controversial tug-of-war in the health care industry. According to The Washington Post, in 11 states nursing groups are pushing legislation that would permit nurses with master’s degrees or higher to order and interpret diagnostic tests, prescribe medications and administer treatments without the supervision of a physician. Similar legislation is likely to be introduced in three other states. Currently, each state decides how much supervision nurses must receive from physicians.

This legislation faces strong opposition from physicians, led by the American Medical Association (AMA). This is according to an article in The Washington Post, published on March 24, 2013. Click here to read that article.

The Fight for Autonomy.

According to The Washington Post, the American Association of Nurse Practitioners (AANP) and other nursing groups are coordinating this legislation effort. These groups are receiving support from consumer advocates and state officials concerned about the possible doctor shortage.

Physicians’ groups are arguing that with little or no supervision, patient care will be compromised, according to a Bloomberg News article. The physicians’ strongest argument is the difference in education between them and advanced practice nurses (APNs). To read the Bloomberg News article, click here.

Difference in Education.

Advanced practice nurses obtain a bachelor’s degree in nursing, then spend between two and three years studying for a master’s degree. A master’s program includes extensive clinical training in addition to class work. One additional year of school is needed to get a Doctor of Nursing Practice (D.N.P.) degree.

Physicians obtain a bachelor’s degree, then continue on with four years of medical school. This is followed by at least three years in a residency program.

Laws for Nurse Supervision Differ State-by-State.

Each state regulates how much oversight nurse practitioners must have. According to Bloomberg News, in 16 states, including Colorado, New Hampshire, New Mexico and Washington, nurses can evaluate and diagnose patients, order diagnostic tests and prescribe drugs. Nurses in these states can start a practice or work in a clinic with no physician present.

Florida and Alabama nurses can’t prescribe controlled substances, including medications for pain, insomnia and attention deficit disorder and must have a supervisory agreement in place with a physician supervisor. Their practice is limited by what the physician places in the agreement.

Court Cases of Nurses vs. Doctors.

According to Bloomberg News, physicians in Iowa sued the state in 2010, after it allowed nurses with advanced training to perform a fluoroscopy, which is a radiographic procedure that takes pictures inside the body. The physicians do not believe nurses have the proper training to carry out this procedure. The case is before the Iowa Supreme Court after a lower court sided with the physicians.

Physicians sued the state of Colorado when the governor allowed nurse anesthetists to work without supervision. An appeals court sided with the nurses in 2012. There is a discussion of this case on our blog. Click here to read it.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians, nurses, nurse practitioners, pharmacists, pharmacies and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Do you think nurses with advanced degrees should be allowed to practice without the supervision of physicians? Do you think it is necessary for patient care for physicians to be present? Please leave any thoughtful comments below.

Sources:

Pettypiece, Shannon. “Nurse Practitioners, Doctors in Tug-of-War Over Patients.” Bloomberg Business Week. (March 7, 2013). From: http://www.businessweek.com/printer/articles/100802-nurse-practitioners-doctors-in-tug-of-war-over-patients

Aizenman, N.C. “Nurses Can Practice Without Physician Supervision in Many States.” The Washington Post. (March 24, 2013). From: http://www.washingtonpost.com/national/health-science/nurses-can-practice-without-physician-supervision-in-many-states/2013/03/24/98b241cc-8745-11e2-999e-5f8e0410cb9d_story.html

About the Authors: Carole C. Schriefer is a nurse-attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

 

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
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