Journal of Gerontological Nursing

LEGAL ISSUES 

Common Causes of Nursing Malpractice

Kay Weiler, RN, MA, JD

Abstract

The essential elements for establishing a claim of nursing malpractice were identified in the last column (Weiler, 1995). The purpose of this column is to identify some of the more common reasons given for bringing a nursing malpractice action.

Some of the most common situations that give rise to malpractice actions are problems associated with: 1) nursing assessments; 2) lack of communication or miscommunication with other health care providers; 3) misuse of equipment or equipment malfunction; 4) mistakes with medication administration; and 5) problems with environmental safety.

Most nursing fundamentals courses teach students to observe the patient and assess the patient for normal and abnormal conditions or behaviors. It is expected that the nurses' assessments will be documented in the patient record. If the assessments are not documented, the very real question arises regarding whether the assessments were ever actually performed. Beckman (1995, pp. 70-71) asserts that "The old adage, 'if the nursing action or observation is not charted, it was not done' still applies today." Therefore, if the nurse is not able to demonstrate through written notes or a flow chart that the observations were made and recorded, the nurse will have diminished credibility in asserting that the patient was assessed and that appropriate care was given.

The lack of communication between nurses and physicians is the second problem that may lead to a nursing malpractice action. While nurses in an acute care and long-term care setting have the responsibility for observing the patient over the entire 24-hour period, physicians only make episodic visits and see the patient for brief periods of time. It is the nurse's responsibility to alert the physician to changes in the patient's condition. Nurses may hesitate to contact physicians because they did not want to "disturb" the physician or because they are not certain if a change in the patient's condition is "significant" (Beckman, 1995). Nurses must recognize that physicians cannot intervene in the patient's care if they are unaware that a problem exists. In examining a malpractice action, the court expects that the nurse is educated and able to make appropriate assessments. If the need arises, the court expects that the nurse will contact the physician and seek a modification in the patient's treatment plan.

Mistakes with medication administration are another source of nursing malpractice actions. All nursing students are taught the five "rights" of medication administration - the right patient, the right medication, the right route, the right dose and the right time. However, many nursing malpractice actions arise from the nurse's failure to determine that all five rights have been maintained. Nursing malpractice actions have been filed because the right medication was given but it was given to the wrong patient. Or the right patient received medication at the appropriate time but it was the wrong medication. Or the correct medication was given to the right patient but the route, dosage or time was not correct. As simple as the medication procedure seems to be, a lack of time or attention to detail may be detrimental to or fatal for the patient who is the recipient of the nurse's mistake.

Problems with the environment may include equipment failure or mismanagement or other problems associated with the patient's environment. Most nurses recognize that there are many sophisticated pieces of equipment being introduced routinely into acute and long-term care facilities. It is easy to identify that new neurological and cardiac monitoring equipment, if it were set up or maintained improperly, could have serious, or lethal consequences. However, sophisticated equipment in the clinical unit, intensive care or operating room, is not the only source…

The essential elements for establishing a claim of nursing malpractice were identified in the last column (Weiler, 1995). The purpose of this column is to identify some of the more common reasons given for bringing a nursing malpractice action.

Some of the most common situations that give rise to malpractice actions are problems associated with: 1) nursing assessments; 2) lack of communication or miscommunication with other health care providers; 3) misuse of equipment or equipment malfunction; 4) mistakes with medication administration; and 5) problems with environmental safety.

Most nursing fundamentals courses teach students to observe the patient and assess the patient for normal and abnormal conditions or behaviors. It is expected that the nurses' assessments will be documented in the patient record. If the assessments are not documented, the very real question arises regarding whether the assessments were ever actually performed. Beckman (1995, pp. 70-71) asserts that "The old adage, 'if the nursing action or observation is not charted, it was not done' still applies today." Therefore, if the nurse is not able to demonstrate through written notes or a flow chart that the observations were made and recorded, the nurse will have diminished credibility in asserting that the patient was assessed and that appropriate care was given.

The lack of communication between nurses and physicians is the second problem that may lead to a nursing malpractice action. While nurses in an acute care and long-term care setting have the responsibility for observing the patient over the entire 24-hour period, physicians only make episodic visits and see the patient for brief periods of time. It is the nurse's responsibility to alert the physician to changes in the patient's condition. Nurses may hesitate to contact physicians because they did not want to "disturb" the physician or because they are not certain if a change in the patient's condition is "significant" (Beckman, 1995). Nurses must recognize that physicians cannot intervene in the patient's care if they are unaware that a problem exists. In examining a malpractice action, the court expects that the nurse is educated and able to make appropriate assessments. If the need arises, the court expects that the nurse will contact the physician and seek a modification in the patient's treatment plan.

Mistakes with medication administration are another source of nursing malpractice actions. All nursing students are taught the five "rights" of medication administration - the right patient, the right medication, the right route, the right dose and the right time. However, many nursing malpractice actions arise from the nurse's failure to determine that all five rights have been maintained. Nursing malpractice actions have been filed because the right medication was given but it was given to the wrong patient. Or the right patient received medication at the appropriate time but it was the wrong medication. Or the correct medication was given to the right patient but the route, dosage or time was not correct. As simple as the medication procedure seems to be, a lack of time or attention to detail may be detrimental to or fatal for the patient who is the recipient of the nurse's mistake.

Problems with the environment may include equipment failure or mismanagement or other problems associated with the patient's environment. Most nurses recognize that there are many sophisticated pieces of equipment being introduced routinely into acute and long-term care facilities. It is easy to identify that new neurological and cardiac monitoring equipment, if it were set up or maintained improperly, could have serious, or lethal consequences. However, sophisticated equipment in the clinical unit, intensive care or operating room, is not the only source of malpractice action involving equipment. The failure to monitor a patient's activity level and an accompanying failure to raise side rails to prevent a patient from falling out of bed may have serious consequences for the patient's recovery. In addition, the failure to properly apply and monitor chest posey restraints in the bed or chair may lead to lacerations, bruises or even strangulation if the patient is inadvertently hung by the protective restraint (Beckman, 1995).

The first column in this series identified the elements of a negligence action. The next column will offer some suggestions for diminishing the nurse's risk of having a patient file a negligence claim.

REFERENCES

  • Beckman, J.P. (1995). Nursing malpractice: Implications for clinical practice and nursing education. Seattle, WA: University of Washington Press.
  • Weiler, K. (1995). Nursing malpractice, journal of Gerontolagica! Nursing, 21(11), 47.

10.3928/0098-9134-19960401-09

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