Showing posts with label Medication Administration Errors. Show all posts
Showing posts with label Medication Administration Errors. Show all posts

Saturday, July 16, 2011

Medication Errors, FDA U.S. Food and Drug Administration

FDA receives medication error reports4 on marketed human drugs (including prescription drugs, generic drugs, and over-the-counter drugs) and nonvaccine biological products and devices.  The National Coordinating Council for Medication Error Reporting and Prevention5 defines a medication error as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use."

The American Hospital Association6 lists the following as some common types of medication errors:

  • incomplete patient information (not knowing about patients' allergies, other medicines they are taking, previous diagnoses, and lab results, for example);
  • unavailable drug information (such as lack of up-to-date warnings);

Please click on the "Via" link for the full article.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Friday, July 8, 2011

When Nurse Make Mistakes (Theresa Brown, RN) - NYTimes.com

This year, a Seattle nurse named Kim Hiatt committed suicide. Ms. Hiatt’s death came nearly seven months after she had given an unintended overdose to an infant heart patient, a medical error that was said to have contributed to the child’s death days later.

Ms. Hiatt had been a nurse for 27 years and had often cared for the 8-month-old girl during the child’s stay in the pediatric intensive care unit of her hospital. She had probably drawn up the right dose of the drug hundreds of times in her career. But once, she made a life-changing error. A baby died, and she was suspended, then fired from a profession she loved. And now she’s dead.

Please click on the "VIA" link to read the full article.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
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Tuesday, May 24, 2011

Many paid caregivers lack health literacy skills :: May 4, 2011 ... American Medical News

More than a third of the people paid to care for seniors are not health literate, and 60% wrongly interpret the instructions on prescription labels, a study says.

Caregivers often are hired by families to help care for seniors with cognitive loss, dementia or Alzheimer's disease and who have trouble performing daily activities such as toileting, bathing, cooking and shopping. This makes it especially important that caregivers have the ability to understand health-related instructions, said Lee A. Lindquist, MD, MPH, lead author of the study published in May's Journal of General Internal Medicine (www.ncbi.nlm.nih.gov/pubmed/21161420/).

Caregivers' poor health literacy skills can affect patient care, said Dr. Lindquist, a geriatrician at Northwestern Memorial Hospital in Chicago.

See also:

Death By Handwriting, By Maureen Glabman, Trustee Magazine :"Most Americans don't receive any formal handwriting instruction beyond the third grade, so how we learned to write then is more or less what we are stuck with for the rest of our lives. It's a worn joke that when someone writes poorly, we tell him he could be a doctor. But a medical error due to misinterpretation of illegible writing is no laughing matter--and for physicians it is a major threat to patient safety. The Joint Commission does not know precisely how often hospitals are reproached for handwriting deficiencies, but the problem is believed to be substantial. "The Joint Commission almost always finds instances where handwriting is of poor quality," says Peter Angood, M.D., JCAHO vice president and chief patient safety officer. The standard that encompasses handwriting legibility also includes stipulations that medical records be dated, that patients be identified and that diagnoses are supported, among other requirements, so it is difficult to sort out individual deficiencies."
http://www.trusteemag.com/trusteemag_app/jsp/articledisplay.jsp?dcrpath=TRUST.../PubsNewsArticleGen/data/2005/0510TRU_FEA_Handwriting

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Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Saturday, May 14, 2011

Silent Treatment Study, silenttreatmentstudy.com #rnchat #nursing #nurses

Research and regulatory bodies have long confirmed that poor communication in healthcare is harmful at best and deadly at worst.

In the 2005 study, Silence Kills, VitalSmarts and the AACN found that 84 percent of healthcare professionals observe colleagues take dangerous shortcuts when working with patients and yet less than 10 percent speak up about their concerns.

Since that time, the healthcare community has turned to safety tools and checklists to reduce unintentional slips and errors. And yet, a new study called The Silent Treatment has found that the effectiveness of safety tools is undercut by undiscussables. Every day, healthcare professionals are making calculated decisions to not speak up—even when safety tools alert them to potential harm.

The Silent Treatment reveals that despite the safety interventions taken in the last decade, silence still kills. Safety tools do not compensate for crucial conversations failures in the hospital.

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Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Tuesday, April 26, 2011

amednews: 1 in 3 patients harmed during hospital stay :: April 18, 2011 ... American Medical News

By Kevin B. O'Reilly, amednews staff. Posted April 18, 2011.

One-third of hospital patients experience adverse events and about 7% are harmed permanently or die as a result, according to a study that detected patient safety problems at a far higher rate than other methods.

The study, in April's Health Affairs, echoes two reports issued in November 2010 that showed rates of adverse events hovering near 25% among hospitalized Medicare patients nationwide and at 10 North Carolina hospitals.

The findings draw attention to the safety troubles that have lingered in U.S. hospitals in the 12 years since the Institute of Medicine's headline-grabbing report "To Err is Human." The study cited research estimating that up to 98,000 patients die each year due to preventable medical errors.

"This is one of the best studies that now gives us a sense of how much harm is happening to patients in American hospitals," said Robert Wachter, MD, chief of the medical service at the University of California, San Francisco Medical Center, who was not involved in the research. "There is a tremendous amount of harm befalling patients who are admitted to hospitals and humongous opportunities for improvement."

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Friday, April 22, 2011

Nurse's suicide follows tragedy | Seattle Times Newspaper

Seattle Times health reporter

Crisis help

Don't wait to seek help if you're in crisis.

In King County, call: 206-461-3222 (TTY/TDD 206-461-3219).

Outside King County, call 800-273-TALK (8255).

The suicide of a nurse who accidentally gave an infant a fatal overdose last year at Seattle Children's hospital has closed an investigation but opened wounds for her friends and family members, as they struggle to comprehend a second tragedy.

Kimberly Hiatt, 50, a longtime critical-care nurse at Children's, took her own life April 3. As a result, the state's Nursing Commission last week closed its investigation of her actions in the Sept. 19 death of Kaia Zautner, a critically ill infant who died in part from complications from an overdose of calcium chloride.

After the infant's death, the hospital put Hiatt on administrative leave and soon dismissed her. In the months following, she battled to keep her nursing license in the hopes of continuing the work she loved, despite having made the deadly mistake, friends and family members said.

To satisfy state disciplinary authorities, she agreed to pay a fine and to undergo a four-year probationary period during which she would be supervised at any future nursing job when she gave medication, along with other conditions, said Sharon Crum of Issaquah, Hiatt's mother.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Monday, April 18, 2011

Not Running a Hospital: Painfully slow

You can already imagine the responses. "That's just in North Carolina." "Our patients are sicker." "There are problems with the data."

What would prompt that? This New York Times article, citing a forthcoming NEJM study about medical errors in North Carolina. Here's the lede:

Efforts to make hospitals safer for patients are falling short, researchers report in the first large study in a decade to analyze harm from medical care and to track it over time.

The study, conducted from 2002 to 2007 in 10 North Carolina hospitals, found that harm to patients was common and that the number of incidents did not decrease over time. The most common problems were complications from procedures or drugs and hospital-acquired infections.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Thursday, April 14, 2011

Drug Errors on the Rise - NYTimes.com

The number of people treated in hospitals in the United States for problems related to medication errors has surged more than 50 percent in recent years.

In 2008, 1.9 million people became ill or injured from medication side effects or because they took or were given the wrong type or dose of medication, compared with 1.2 million injured in 2004, according to the Agency for Healthcare Research and Quality.

Although several national reports in recent years have sounded the alarm about the toll of medication errors, the latest data show the problem continues to persist. The A.H.R.Q. data measure only patients treated in the hospital or emergency department as a result of a medication error. The data don’t distinguish between prescribing, dispensing or consumer errors. Some of the errors resulted from a physician prescribing the wrong drug or dose; others occurred because a pharmacist or nurse gave the wrong drug, or because a patient at home used the wrong type or dose of medication.

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Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Partnership for Patients - Win, Win, Win for American Healthcare

It's called the Partnership for Patients.  (I like it already - it's focused on patients.)  It's a program being developed by the federal government, under Secretary of HHS (Health and Human Services) Secretary Kathleen Sebelius, along with CMS (Center for Medicare Services) Dr. Donald Berwick, a man with an impeccable patient safety advocacy record.  But they aren't in it alone - they have dozens of private and public organizations backing them, as members of the partnership.

Can this possibly be

  • A WIN for patients.
  • A WIN for providers.
  • And a WIN for payers, too?

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Thursday, April 7, 2011

Errors still common in U.S. hospitals | Reuters

About one in three people in the United States will encounter some kind of mistake during a hospital stay, U.S. researchers said Thursday.

The finding, which is based on a new tool for measuring hospital errors, is about 10 times higher than estimates using older methods, suggesting much work remains in efforts to improve health quality.

"Without doubt, we've seen improvements in health care over the past decade, and even pockets of excellence, but overall progress has been agonizingly slow," said Susan Dentzer, editor-in-chief of Health Affairs, which published several studies on a special issue on patient safety.

The special issue came 10 years after an influential Institute of Medicine report that found significant gaps in health quality.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Wednesday, March 30, 2011

How safe is your hospital? - chicagotribune.com

Just before it was disclosed that a medical error at the University of Chicago led to the death of James Tyree, a well-known financier and philanthropist being treated for cancer, I was putting together a presentation examining the quality of care at some of the area's best-known hospitals.

Using publicly available data, I told a meeting of local health care executives that there were warning flags at several institutions, including the U. of C. Tyree, ironically, would have known about any actual problems in far greater detail. He served on the board of the hospital where he died from an air embolism in a dialysis catheter, and hospital officials said in an interview that they regularly report safety data to board members.

There's an important distinction between great doctoring and great safety. The U. of C. has a reputation for outstanding cancer care. That's likely the reason that Tyree, suffering from stomach cancer and pneumonia, had a relatively good prognosis when he entered the hospital and why his death so shocked his family and friends. But as a wise physician once warned, "Every hospital should have a plaque at its entrance that reads, 'There are some patients whom we cannot help; there are none whom we cannot harm.'"

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Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

150,000 + Nurse-Reviewed & Approved Nursing Links

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Monday, March 28, 2011

Nursing Malpractice Case Studies By Date, NursingCaseStudy.com

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Editors Note: The urls to these cases are Permanent and Will Not Change. Feel free to link to any case you feel is helpful. To host any of our cases on your website or reproduce them in your publications, please contact Andrew Lopez, RN

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Physician Dismisses Nursing Assessments, Patient Almost Loses Limb.
Rowe v. Sisters of Pallottine Missionary Society, 2001 WL 1585453 S.E.2e – WV
Summary: The patient was involved in a motorcycle accident in which his bike fell onto and injured his left leg. When the nurses assessing the patient could not detect a pulse in that leg, an ominous sign of circulatory failure. The physician when notified chose to dismiss this fact and discharge the patient. The patient would return soon after with worsening symptoms that would require emergency surgery. Should the nurses have initially pressed for further action, treatment?
http://www.nursefriendly.com/041013

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Extravasation Follows Chemotherapy Administration. Potential Complication or Nursing Negligence:
Iacano v. St. Peter's Medical Center, 334 N. j. Super. 547 – NJ (2000)
Summary: Intravenous therapy has inherent risks and potential complications. When you introduce chemotherapeutic drugs and known vesicants, those risks increase dramatically. In this case, a known risk, extravasation, occurred following administration. The question arises, could the nurses have acted sooner to prevent the extravasation and resulting tissue damage.
http://www.nursefriendly.com/nursing/clinical.cases/040130.htm

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Patient Falls While Ambulating Post-op, Negligence or Medical Malpractice:"One of the most important interventions post-operatively is to get a patient up and walking. It minimizes chances of complications such as DVT, Pneumonia, Pulmonary Emboli and Decubitus Ulcers. In this case, a patient fell while ambulating. It would need to be decided if a case could be made for simple negligence on the part of the staff, or true medical malpractice."
McBee v. HCA Health Services of Tennessee, Inc. 2000 WL 1533000 So.2d – TN
http://www.nursefriendly.com/nursing/clinical.cases/040109.htm

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January 29, 2002: Nurse Sued For "Too Many Sticks" How Many Attempts Is Too Many?:"Starting Intravenous Lines and Performing Venipunctures are basic nursing skills in the Acute Care or Hospital settings. In this case, a female patient would accuse a male nurse of negligence and causing a resulting injury when he needed three attempts to successfully start an intravenous catheter."
Coleman v. East Jefferson General Hosp., 747 So.2d 1044- LA (1999)
http://www.nursefriendly.com/nursing/clinical.cases/020129.htm

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September 4, 2001, Pathologic Fracture, or Patient Injured in Fall:
Summary: The patient in this case had an extensive Oncologic history including multiple metastases and a predisposition to pathological fractures. When the patient fell while transferring a wheelchair, the cause of the broken hip found after the fall was put into question.
http://www.nursefriendly.com/nursing/clinical.cases/2001/090401.htm

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May 13, 2001: Chronically Ill Child or Mother With Munchausens Syndrome
Summary: A child starting at the age of six months was diagnosed with ulcerations of the digestive tract. His treatment and complications would persist well into the age of seven. Identification of Munchausen victims is notoriously difficult under the best of circumstances. In this case, the victim was a child admitted to a Massachusetts Hospital for a Central Venous Catheter, Line infection. The suspicion, diagnosis and treatment were carried out promptly.
Adoption of Keefe, 733 N.E.2D 1075 - MA (2000).
http://www.nursefriendly.com/nursing/clinical.cases/2001/051301.htm

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October 22, 2000: Trauma Patient, In Shock And In Decline, ER Physician Does Not Transfer
Summary: When a patient from a trauma scene arrives at the hospital, initial assessments and evaluations are critical. In this case, a patient involved in a Motor Vehicle Accident was brought in with symptoms indicative of Shock. On evaluation the decision was made to treat the patient on site. The patient then would die soon after admission. Should the ER physician have transferred her?
http://www.nursefriendly.com/nursing/clinical.cases/2000/102200.htm

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October 15, 2000: Physician Restraint Orders Unclear On Transfer, Do You Apply In The Interim?
Summary: The use of Mechanical or Physical Restraints on confused patients is highly controversial. Due to substantial Death & Injury attributed to their use they are considered a last resort measure in providing for the safety of a patient. In this case, orders specifying what restraints and when they were to be used were unclear. In a patient that was clearly at high risk for injury, should they have been applied till the physician could have been contacted?
Tousignant v. St. Louis County, 602 N.W.2d 882 - MN (1999)
http://www.nursefriendly.com/nursing/clinical.cases/2000/101500.htm

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February 16, 2000 Nurse Advises "Reconsider Choice of Physicians" An Nurse's Ethical Dilemma.
In this case the nurse providing patient care noted a decline in the patient's condition, evidenced by weight loss, hallucinations, psychiatric symptoms, and acute distress. The findings were documented and attempts were made to contact the attending physician. The attending physician, however, failed to return any of telephone messages.
Deerman v. Beverly California Corp., 518 S.E.2d 804 - NC (1999)
http://www.nursefriendly.com/nursing/clinical.cases/2000/021600.htm

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January 13, 1999: Cytomegalovirus Test Result, Misinterpreted By Nurse. Did Negligence Lead to Child With Birth Defects?
Summary: Nurses access and report confidential and sensitive test results to case managers, insurance companies, physicians and other nurses as a matter of course each day. It is commonly accepted that only a physician can interpret what a test result implies for a specific patient. Nurses by training have a general knowledge of basic lab values and what they may represent. In this case, a pregnant woman with an active Cytomegalovirus infection was misinformed by a nurse reporting a result. Had an accurate explanation been given, a therapeutic abortion might have been performed.
Duplan v. Harper, 188 F.3d 1195 OK - (1999).
http://www.nursefriendly.com/nursing/clinical.cases/011300.htm

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October 17, 1999: Psychiatric Nurses "Miss" Festering Wound Infection? Is She Held To The Same Standard?
Summary: Registered Nurses in their training cover each of the accepted areas that a new graduate might be expected to work in. Once in the field, it is expected that additional and specific training to a Department or Specialty will be obtained. In this case, the Psychiatric nurses did not pick up on a festering infection in a patient that had tried to commit suicide. Was the fact that they were Psychiatric nurses a valid excuse?
Latshaw v. MT. Carmel Hospital, 53 F. Supp. KL - (1999)
http://www.nursefriendly.com/nursing/clinical.cases/101799.htm

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October 10, 1999: Nursing Malpractice Alleged When Suspected Breast Cancer Patient Doesn't Follow Up
Summary: Breast Cancer is a well-defined and treatable if not always curable disease process. Once suspicious findings-lumps, nodules, nipple discharge or other telltale signs of a problem are noted-prompt evaluation and follow-up care is essential. In this case, a patient with a family history of breast cancer presented with a "mass" and was evaluated. She did not follow-up as directed and when she later died of breast cancer, her estate would sue for "failure to diagnose, treat."
Michigan Ave. Not. Bank v. County of Cook, 714 N.E.2d 1013 - IL (1999)
http://www.nursefriendly.com/nursing/clinical.cases/101099.htm

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October 3, 1999: Grand Mal Seizure Follows Cervical Myelogram, Anticipated Risk or Nursing Negligence?
Cascio v. St. Joseph Hosp., 734 So.2d 1099 - FL (1999)
Summary: With a proper Informed Consent obtained, it is accepted that a patient is aware of potential risks & complications prior to a procedure. In this case, following a cervical myelogram, a patient developed seizures and suffered an injury. The physician would blame the nursing staff for causing an "increased risk" by not following procedures.
http://www.nursefriendly.com/nursing/clinical.cases/100399.htm

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September 26, 1999: Nursing Assistants Leave Client Alone, Patient Receives Second Degree Burns During Bath.
Registered and Licensed Practical Nurses frequently delegate responsibilities and tasks to Certified Nursing Assistants and Unlicensed Assistive Personnel. It is clearly recognized that they are responsible for the actions/inactions of those they supervise. In this case, two nursing assistants recognized injuries to a patient while giving a bath. When they failed to notify the nurse of the injuries, they would be reported and lose their certifications.
http://www.nursefriendly.com/nursing/clinical.cases/092699.htm

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September 19, 1999: Abusive Psychiatric Patient Restrained, Placed In Seclusion For Angering Nursing & Medical Staff?
Summary: In dealing with violent, abusive or angry psychiatric patients, the safety of the patient and staff are the priority concerns. When restraints or seclusion are deemed necessary, justification for the measures must be documented concisely. In this case, an unruly patient angered the nurse caring for him. When leather restraints were applied and maintained for a prolonged period of time, the patient would object and later sue for damages.
Alt v. John Umstead hospital 479 S.E. 2d 800
http://www.nursefriendly.com/nursing/clinical.cases/091999.htm

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September 12, 1999: Sleep Apnea Monitor Turned off or Ignored By Nursing Staff, Patient's Coding Goes Unnoticed.
Monitors and Monitored patients present special challenges to practicing nurses. Like a call bell, when alarms on a monitor are activated, they can signal benign or life-threatening events. In this case, a patient's monitors did not alarm as expected. The patient was in distress and would be found without respirations and pulseless by the nurse on duty.
Odom v. State Dept. of Health and Hosp., 322 So. 2d 91 -LA (1999)
http://www.nursefriendly.com/nursing/clinical.cases/091299.htm

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September 5, 1999: Sealed "Rape Kit" Reopened By Nurse. Evidence Inadmissible?
Documentation of observations and findings are basic to nursing practice. Our practice is governed by standards of practice and "protocols" to be followed. In this case, a nurse admitting a rape victim collected and placed in a "rape kit" DNA samples, evidence to be submitted for laboratory analysis. The evidence submission protocol would inadvertently be broken by the nurse. The defense for the rapist would argue this breach made the evidence inadmissible.
State v. Southern, 980 P.2d 3 - MT (1999)
http://www.nursefriendly.com/nursing/clinical.cases/090599.htm

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August 29, 1999: Surgeon "Loses Clamp" Behind Patient's Heart During Bypass.
Nurse's Responsibility To Pick Up?
Summary: During any surgical operation, there is an inherent "duty" owed to
the patient that the operation will be carried out competently. This
includes carrying out specified procedures and taking measures to prevent
"foreign" objects from being left in the body cavity. In this case, during a
coronary artery bypass grafting, a clamp slipped from the surgeon's sight.
It would be found on x-ray later sitting behind the patient's heart.
http://www.nursefriendly.com/nursing/clinical.cases/082999.htm

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August 22, 1999: Psychiatric Nurse, Sued By hospital After Developing Relationship With Client?
Wright v. Mercy Hosp. Of Janesville - 557 N.W. 2d 846 - WI (1996)
Summary: Doctors and Nurses by nature of their positions deal with patients when they are vulnerable, off-balance and emotionally needy. When the population includes the psychiatric patient, the potential exists for a client to develop "feelings" for the caregiver. In this case, a sexually abused mother of three was admitted for multiple mental disturbances. During the course of the treatment, a relationship developed and led to sexual encounters following discharge. When it came to light, the patient successfully sued. The hospital would attempt to recover damages against the nurse following her testimony in defense of the facility. This is commonly called a Subrogation action.
http://www.nursefriendly.com/nursing/clinical.cases/082299.htm

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August 15, 1999: Violent Psychiatric Patient Attacks Nurse,
No Legal Recourse Against Facility or Psychiatrist?
Charleston v. Larson, 696 N.E. 2d 793 – IL 1998
Summary: It would seem absurd, that if a physician admits and facility assigns a nurse to care for a known violent patient, that it has no legal obligation to protect that nurse against violence. In this case, a psychiatric patient sought admission to facility. On admission, he threatened to attack a nurse. When the patient would follow through on his threat, the nurse was denied legal recourse against the psychiatrist who could have taken precautions against the attack.
http://www.nursefriendly.com/nursing/clinical.cases/081599.htm

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August 8, 1999: Pregnant Prison Inmate Complains of Miscarriage, Corrections Nurse On Duty Ignores Symptoms?
Ferris v. County of Kennebec, 44 5. Supp.2d 62 –ME (1999)
Summary: Nursing assessment skills are one of our most valuable assets. They allow us to effectively evaluate our patients and communicate significant findings to physicians and other members of the healthcare team. In this case, a pregnant woman with a previous history of miscarriage complained of vaginal bleeding and abdominal discomfort. The assessment performed by the nurse fell negligently short of the required standard of care.
http://www.nursefriendly.com/nursing/clinical.cases/080899.htm

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August 1, 1999: Nursing Duty To Patient, "Does Not Guarantee" Safety Or Quality Of Care.
Summary: When a nurse accepts report and responsibility for the care of a patient a duty to the patient is also accepted. This duty is to provide a reasonable standard of care as defined by the Nurse Practice Act of the individual state and the facility Policy & Procedures. In this case, a post-op abdominal aneurysm repair patient was injured after falling from his bed to the floor. When a lawsuit was filed the court initially mistook expert testimony to imply the role of the nurse includes a guarantee of safety.
Downey v. Mobile Infirmary Med. Ctr. - 662 So. 2d 1152 (1995).
http://www.nursefriendly.com/nursing/clinical.cases/080199.htm

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July 25, 1999: Premature Child of Cocaine Addicted Mother Survives Abortion. Physician Order: Leave To Die?
The premature birth of a child under normal circumstances requires highly skilled nursing and medical care if the child is to survive. The birth of a premature child to a known Cocaine addicted mother greatly increased the risks of mortality. In this case, a child intended to be aborted is born alive. When the physician orders that the child be to left to die, it miraculously survives on its own. Were the nurses liable for "following orders?"
Hartsell v. Fort Sanders Reg. Med. Ctr. 905 S.W. 2d 944 - TN (1995).
http://www.nursefriendly.com/nursing/clinical.cases/072599.htm

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July 18, 1999: Good Samaritan Laws & Acts. Do They Cover Nurses Volunteering Nursing Care When A Citizen Goes Anaphylactic.
"Off-duty" healthcare professionals renderingEmergency aid are in most cases "covered" by the Good Samaritan Acts.  These are laws enacted in each state that provide some degree of immunity from liability for good faith efforts in giving emergency care.  In this case, a nurse and physician were sued for providing assistance in a volunteer function at a "first-aid" station. Good Samaritan "immunity" was not recognized by the courts.
Boccasile v. Cajun Music Ltd. 694 A 2d 686 - RI (1997)
http://www.nursefriendly.com/nursing/clinical.cases/071899.htm

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July 11, 1999: Nursing Home Rehabilitation Stay Proves Terminal. Was Quality of Care Given An Issue?
Nursing homes are frequently a patient's destination for rehabilitation following surgery.  Common conditions fitting this bill include large bone fractures, hip replacements and stroke. Following these acute episodes, the patients are too unstable to go home and not "sick" enough to have their hospital stays reimbursed by insurance companies.  The purpose of admission to a nursing home is to help the patient regain lost function, strength and health.  In this case, the patient would remain in the Nursing Home till her death of complications.
Lloyd v. County of Du Page, 707 NE.2d 1252 - IL (1999)
http://www.nursefriendly.com/nursing/clinical.cases/071199.htm

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July 4, 1999: Diabetic Coronary Artery Bypass Patient, Septic & Noncompliant.  Nursing Duty and Responsibility Questioned.
Patient noncompliance can present serious challenges to nurses  and physicians providing care.  If aware of the proper measures to be taken, what happens when the patient does not agree or comply with the course of treatment?  In this case, a patient after having a coronary artery bypass grafting developed a sternal infection. When advised by a nurse to return for treatment, the patient refused.
Kind v. State Ex Rel. Dept. of Health, 728 S.o. 2d 1027 -LA (1999).
http://www.nursefriendly.com/nursing/clinical.cases/070499.htm

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June 27, 1999: Elderly Patient Repeatedly Injured In Nursing Home "Accidents." Negligence, Coincidence or Abuse?
As the elderly population continues to increase, more and more families are faced with the decision to place loved ones in nursing homes.  When a family member is placed in a facility, a certain standard of care is expected.  In this case, a resident was injured repeatedly while under their care.  When the patient died a few days after being "dropped" the family sued.
Brickey v. Concerned Care of Midwest Ince. 988 S.W. 2d 592 MO (1999)
http://www.nursefriendly.com/nursing/clinical.cases/062799.htm

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June 20, 1999: Organ Donation Informed Consent, Is A Single Parent's Sufficient?
Organ donors are in high demand.  Frequently intended recipients can wait a lifetime for the critical matching organ.  In this case, two nurses obtained a consent from a child's mother.  When the father later expressed his disagreement, the child's corneas had been harvested and it was too late.
Andrews v. Alabama Eye Bank, 727 S. 2d 62 –AL (1999)
http://www.nursefriendly.com/nursing/clinical.cases/062099.htm

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June 13, 1999: Felony Child Abuse Conviction, Made Possible Thanks to Nurse's Documentation.
Child abuse is a "reportable" crime.  This means when a healthcare worker suspects in the course of their duties that a child has been abused, it must be reported.  Procedures are in place in hospitals and other facilities for the reporting of abused children. In this case, it was the expert documentation of a child's statements by a nurse, physician and field agent that made the conviction of an abuser possible.
State v. Gillard, 936 S.W. 2d 194 - MO (1999).
http://www.nursefriendly.com/nursing/clinical.cases/061399.htm

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June 6, 1999: Emergency Department Nurse Verbally Abused, Physician History Well Documented
Official tolerance for verbal abuse and sexual harassment is approaching zero.  It is clear that both are still prevalent in healthcare settings today.  Enforcing and reporting instances of abuse are critical to an end being put to the situation.  In this case, a physician had a "history" of verbal abuse in the facility involved.  It was the documentation of previous events that made formal action and administration of a suspension feasible.
Gordon v. Lewiston Hospital, 714 A.2d 539 – PA (1998)
http://www.nursefriendly.com/nursing/clinical.cases/060699.htm

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May 30, 1999: Patient Left Unrestrained, Patient Injured. Nurses Judgement Call
The decision to use or not use restraints must be made with caution and good judgement. Their intended purpose must be to protect either the patient or others who may be injured by the patient including the staff caring for the client. The ultimate determination of necessity is left with the physician. Often, the moment to moment necessity is determined by the nurse. In this case a nurse did not feel restraining the patient was necessary. When an injury occurred, the patient sued.
Gerard v. Sacred Heart Medical Center - 937 P. 2d 1104 (1997)
http://www.nursefriendly.com/nursing/clinical.cases/053099.htm

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May 23, 1999: Sponge Count Off, Patient Develops Sepsis, Surgeon Blames Nurse.
Sponge Counts are a basic and critical safety measure during a surgical operation.  In this case, the standard three counts were not performed.  A sponge was left in the patient that would later lead to infection.  When the issue went to court, the surgeon claimed "it was not his responsibility" to keep track of the sponges.
Johnston v. Southwest Louisiana Assn. 693 So. 2d 1195 –LA (1997)
http://www.nursefriendly.com/nursing/clinical.cases/052399.htm

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Editors Note: The urls to these cases are Permanent and Will Not Change. Feel free to link to any case you feel is helpful. To host any of our cases on your website or reproduce them in your publications, please contact Andrew Lopez, RN

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Sunday, March 27, 2011

Admitting harm protects patients - Sunday, March 27, 2011 | 2 a.m. - Las Vegas Sun

As Nevada legislators debate this week whether to require hospitals to publicly report when they harm patients, they could learn a lot from Paul Levy’s experience in pulling back the veil of hospital secrecy.

Levy became a revolutionary figure in medicine when, as CEO of Beth Israel Deaconess — then the weak sibling among Harvard University’s teaching hospitals — he began blogging about injuries and infections suffered by his hospital’s patients. His competitors eventually followed suit and now, with Massachusetts law imposing transparency, they acknowledge openness has brought greater accountability and a more focused commitment to protecting patients.

“It’s not just fear of public embarrassment” that drives the improvements, said Dr. Ken Sands, chairman of Beth Israel Deaconess Medical Center’s health care quality department. “It’s an easy way to show something is a priority and is deserving of attention.”

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Saturday, March 19, 2011

How to Give an IM Injection, Kathy Quan RN BSN

When it is necessary to inject medication, the route is determined by the chemical make up and viscosity of the medication. Many times the route will be intramuscular (into the muscle) known as an IM injection or "shot' as opposed to subcutaneous or intradermal injection.

The injection site will be determined by the volume of medication to be injected. Other considerations are the age of the patient, the size and weight of the patient and mobility issues. The patient’s ability to relax and cooperate can also play a role in determining a safe injection site. Needle size depends on factors such as the site, medication and size/weight of the patient.

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Sunday, March 13, 2011

Pain Medication Mistakes: Overdoses, Side Effects, and More

It's been a hard day, and Joe's back is killing him.

His wife has some Percocet left over from a trip to the dentist, and there's that big bottle of Tylenol under the sink, so Joe grabs a couple of each and washes them down with a slug of beer.

Luckily for Joe, he's a fictional character invented for this article. But there are a lot of real-life Joes out there making big mistakes with over-the-counter and prescription pain pills.

Can you spot Joe's mistakes? Joe didn't make every mistake in the book. But he made quite a few.

Here's WebMD's list of common pain pill mistakes, compiled with the help of pharmacist Kristen A. Binaso, RPh, spokeswoman for the American Pharmacists Association; and pain specialist Eric R. Haynes, MD, founder of Comprehensive Pain Management Partners in Trinity, Fla.

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