November 1, 2007 | American Society of Registered Nurses®
Journal of Nursing

Examining Medication Errors

Medication Errors

Ronald filed a lawsuit against a popular Health Care center in Virginia that was responsible for his wife's death in Jan 2004. He alleged that she died from sepsis due to multiple urinary tract infections she had developed due to poor infection control methods, during assisted toileting (Patricia, 2005).

These episodes of medical compensations apart from helping the victims, highlights the errors and negligence occurring in treatment situations and need to raise the medical care standards. The death of Nardia, 32, in Feb 2002 after a hysterectomy at Mater hospital has brought the hospital under scrutiny (Patricia, 2005).

Thus, any errors in patient care often results in patient's death due to multiple complications and lead a nurse into serious medical litigations under the medical malpractice law. Medical malpractice law in USA is part of tort, or personal injury law.

Patient's perceptions of health care, particularly disagreements and researches of various kinds with medical professionals have caught the attention of every one since 1980s. These disagreements have turned often into legal complaints (Ellen Annandale 1998).

These disagreements turned legal complaints lead to long medical litigations, which have redefined nursing practices to fit into the changing health delivery system. The nursing practice is liable for six kinds of legal authority, viz, "The federal or central law", "The law of the state", The "International code", "Institutional rules and regulations", "Standing orders of the chief" and "Precedent court decisions". (Zwemer, 1995).

Adverse Medical Event

An adverse medical event is an injury caused due to medical treatment rather than the disease for which the patient is treated. This adverse medical event prolongs the hospitalization process causing disabilities, either permanent or temporary.

An adverse medical event due to negligence thus, is an injury, proved to be due to the sub-standard medical care, not expected of a medical professional. An adverse medical event can be a temporary disability or even death due to injury. In most of the medical litigations, the severity of the patient disability has been predictive in judgments in favor of the patients.

The Court can award three types of damages in such medical litigations:

1.Compensatory damages -for an injured plaintiff's economic losses, costs of health care and lost wages.

2. Compensatory damages -for non-economic losses including pain, suffering associated to injury, and

3. Punitive damages -in cases where a defendant (here, a medical professional) has been found to have acted in a willful fashion, demonstrating negligence with no regard for the patient's well being.

Thus, punitive damages aim to punish the defendants and are very damaging to the nurses. Hence, there seems today, a departure from traditional approach to management of disputes between the healthcare professionals and the patient .The practice includes Documentation based Practice; Evidence based Practice and New Medical Guidelines and laws

Documentation Based Practice

Documentation based Medical Practice includes documentation of the Informed consent, Health Record, Advance Directives, Living will and Treatment Report. One of the most difficult realities of the medical practice is that, despite efforts and good care, some patients will die, either due to the nature of the disease like cancer, AIDS etc, or due to developments related to patient's age, health conditions etc.

Although technological advances in health care bring extended and improved quality of life, the ability of these technologies to prolong life beyond a meaningful point has raised ethical issues, especially in "nothing more can be done" patients (Kubler-Ross, 1969). The case of Nancy Curzon throws more light on the legal implications of most medical practice decisions. Nancy Curzon was a young woman involved in a car crash after which she remained in a persistent vegetative state in U.S.A.

In spite of a three year legal battle of her family members to have her feeding tube removed to let her die, The Supreme Court ruled that a state requires "clear and convincing evidence" of the patient's wishes for withdrawal of life-support (McSkimming et.al, 1994). This gave rise to the legislations, which encourage people to prepare advance directives in which they indicate their wishes concerning the treatment and care to be provided if they become incapacitated.

Advance directives are legal documents that specify a patient's wishes before hospitalization and provide the necessary information for tough decision-making situations (Suzanne 2004). The Advance directive is usually composed of a Living will, which is a medical directive issued by an individual with sound mind. This documents treatment preferences and provides instructions of care. This is often accompanied by a "proxy directive".

A proxy directive is the appointment and authorization of another individual to make medical directives on behalf of the person who created an advanced directive when he/she is no longer able to speak for himself/herself. This is known as Health Care Power of Attorney or "Durable Power of Attorney".

Assisted suicide is a criminal offense except in the state of Oregon, U.S.A where there is a statute legalizing physician assisted suicide. Apart from this, every Health Care center today provides a report to the patient on the details of the diagnosis of the disease with follow up instructions, the medicine information and the allergy reactions that could follow; dietary restrictions, dos and don'ts, restrictions and exercises prescribed.

They take an acknowledgement either from the patient or an authorized person after receiving the report. This documentation serves a key purpose in medical practice (Hackensack University Medical Center, 2006). The health record is another important document, which records the written and legal evidence of treatment. This reflects only facts and not the judgment of the nurses.

Careful and accurate documentation is vital for patient welfare and that of the nurse. The use of electronic documentation is becoming increasingly prevalent (Bunker, 1999). Before any terminally ill person receives his chemotherapy or an invasive procedure, he or his health attorney should give a well-documented informed consent. Informed consent means that tests, treatments and medications have been explained to the person, as well as outcomes, possible complications and alternative procedures.

Evidence Based Medical Practice

Evidence based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the case of individual patients (Sackett, 1996). Evidence based medical practice at a broader level provides a safe framework in which different groups can make tough decisions by safe guarding their concerns by a fair and scientifically sound process (Baum, 2003).

The Medical Guidelines

The Medical Guidelines and laws in USA help manage medical errors better. The expert witness plays an essential role in determining medical negligence under the US system of jurisprudence. As per USA jurisprudence system, the standard of nurse care is different from the quality of care (Simon, 2004).

The standard of care is a legal concept, normatively defined, that is applied to the specific fact pattern of a case in litigation (Simon, 2004). The definition of standard of care differs between states in USA. Quality of care is defined as the adequacy of total care the patient receives from health care professionals, including third-party payers (Simon, 2004).

Conclusion

Today, nursing is a profession rather than a vocation. The profession is "accountable" and obliged to the laws regulating the professional activity (Suzanne et.al, 2004).

The increase in frequency of medical litigations can be attributed to greater public awareness of medical errors, loss of confidence in health care delivery system, technological advancement, increased expectations of medical care and reduced interest of the plaintiff in accepting compensations outside the preview of the jury due to higher compensation chances through jury (Brennan.T 2004).

References

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  • Ann J. Zwemer (1995). Professional Adjustments and Ethics for Nurses in India. 6th edn, B.1 Publications, India.

  • Annandale, E. (1989). The malpractice crisis and the doctor-patient relationship. Sociology of Health and Illness 11:1-23.

  • Bojan Pancerski. (2006). British Medical Journal. 332:382.

  • Bosk. C. (1979). Forgive and Remember: Managing medical failure, Chicago University Press, Chicago.

  • Brennan, T, et.al. (1991). Incidence of adverse events and negligence in hospitalized patients: the results of the Harvard Medical Practice Study. New England Journal of Medicine 324: 370-76.

  • Brunner & Suddharth's, Suzanne C. Smeltzer, Brenda.G. (2004). Textbook of Medical Surgical Nursing. 10th edn Lippincott U.S.A.

  • Claire Wallerstein (2005). British Medical Journal. 330:1044.

  • Clare Dyer (2006). British Medical Journal. 332:13521.

  • Clare Dyer (2006). British Medical Journal, 332:623.

  • Editorial (2005) British Medical Journal 331:923. 22 .

  • Hackensack Medical Center- Emergency Dept Report, Hackensack University Medical Center, NJ, 02/19/2006.
  • Kubler ? Ross E (1969) On death and dying, Macmillan, New York.

  • Mc Skimming S.A, Super, A., Driever, M.J, Schoessler, M., Franey S.G & Fonner E, (1997) Living and Healing during life?threatening illness; Portland.

  • Mulcahy, L (2003). Disputing Doctors: The socio-legal dynamics of disputes between doctors and patients, Open University press, Milton Keynes.

  • Neil H.Baum. (2003). Support your decisions with Evidence based Medicine, "Urology Times". Feb 1.
  • Patricia A Potter, Anne Griffin Perry. (2005) Fundamentals of Nursing, 6th edition, Mosby .

  • Shelby Hixson, Tracey King (1998). Nursing Strategies to Prevent Ventilator-Associated Pneumonia, AACN Clinical Issues: Advanced Practice in Acute and Critical Care. 9(1).

  • Simon RI (2004). Assessing and Managing Suicide Risk; Guidelines for Clinically Based Risk Management.. American Psychiatric Publishing, Inc., VA.

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    >How Severe Is Nurse Burnout In The Emergency Department?

    >Can Core Nursing Values And Ethics Be Taught?

    >Critical Thinking And Evidence-Based Nursing

    >Emotional Intelligence In The Nursing Profession

    >Examining Medication Errors

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