Health care providers are responsible for ensuring patient safety and quality of care at all times. Nurses play a vital role in provision of patient care. Many of the tasks of nursing carry some degree of risk, with medication administration having one of the greatest risk factors. Serious errors may occur in approximately 2 per 1,000 prescriptions (Lesar et al, 1990). The rate of adverse drug events are estimated at approximately 1%, with 12% to 30% of them classified as serious of life threatening ( Lindquist & Gersema , 1998).
Health care providers enter into a trust relationship with their patients, none more so than nurses. It is the betrayal of trust that is often part of the motivating factor of patients and their families when malpractice claims are brought against health care providers (Kraman & Hamm, 1999).
In Florida a young woman with Guillian-Barre syndrome died from a medication error. The case went to court and a multimillion dollar settlement was reached when it was determined the woman was given succynylcholine which causes a fatal reaction in those with Guillian-Barre (floridahealthcarelaw.
Another case which resulted in a fatality involved a 32-year-old woman who underwent removal of her tonsils and adenoids. Her post op analgesia included a PCA, Phenergan 25mg IV q 4 hours prn for pain, Compazine 10 mg po q 4 hours prn for nausea, Benadryl 50 mg po q 4 hours for itching and Halcion 0.25 mg hs. The PCA was set for 1mg /activation with a 6 minute lockout a bolus of 5mg morphine plus 25 mg Phenergan was given IV. Pt was administered 25 mg Phenergan IV at 1500 and 1900 and 50 mg Benadryl at 1900.
The patient reported nausea at 2000 requesting Tums. The nurse reported to the patient that the medication was not ordered, but the physician could be contacted to ask for an order. The nurse also informed the patient that Compazine was ordered for nausea. The patient chose to take Compazine and 10 mg was given at 2030. At 2100 0.25 mg Halcion was administered for sleep. At 2400 the patient was found cyanotic and unresponsive and could not be resuscitated. She died from a medication overdose (Benjamin, 2003).
A third case from Britain involves a nurse who substituted Actrapid instead of giving Mixtard as ordered. Both of these drugs are insulins. The nurse claimed the correct insulin was not in the medication refrigerator. When confronted by her superior regarding the substitution the nurse stated she did not want the patient to have to wait for the time it would take for the correct medication to arrive from pharmacy. The nurse also did not alert other staff to the fact she had given a shorter-acting insulin so the patient could be more closely monitored. The actions of the nurse put the patient at risk. An investigation was conducted and the nurse was found guilty of gross professional misconduct and her name was removed form the UK nursing register (British Journal of Nursing, 2003).
Cases such as these can result in lawsuits being brought against the healthcare team involved in the patient’s care and the healthcare facility. In order malpractice to be determined four elements are required: 1) a professional relationship has to exist between the patient and the healthcare provider. 2) The conduct of the professional has to be below the standard of care 3) damages occurred (patient was injured), and 4) the actions of the healthcare provider was the cause of the damages. Malpractice cannot always be determined, but can result in multimillion dollar settlements. Often disciplinary actions are taken that result in termination of employment and loss of licensure. If death or disability resulted from the error the healthcare provider often is left with permanent psychological scars.
The six rights of medication administration were put in place to decrease the risk of medication errors. These consist of the right patient, drug, dose, route, time and documentation. There is a push to include the nine rights of medication administration, adding the right action, form and response. If these measures are taken consistently avoidance of medication errors can be greatly reduced and events such as the above can be avoided.
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