Question

Discuss what action a caregiver should take, if any, if a physician’s written orders appear questionable.

Answer 1

Medical malpractice can be caused by a number of different actions (or failures to act) on the part of a health care professional, but the main cause of medical malpractice will always boil down to medical negligence, which means a health care provider’s failure to exercise the degree of care and skill of a competent health care provider who practices the provider’s specialty, taking into account the advances in the profession and resources available to the provider.

Prescription drug errors are a common form of medical malpractice, and we'll discuss these cases in detail in this article.

What is a Prescription Drug Error:-

There are numerous types of prescription drug errors. Some of the more common include:

• administering the patient the wrong medication
• administering the patient the wrong dosage of medication (i.e., too much or too little medication)
• mislabeling the medication
• prescribing the patient a medication that the patient is allergic to
• prescribing the patient a medication that interacts negatively with other medications that the patient is taking, andfailing to warn the patient of the common side effects of the medication

Administering Wrong Medication or Wrong Dosage:-

Physicians and nurses can be liable for prescribing and/or administering the wrong medication. They can simply make a mistake about what medication should be prescribed or what dosage to prescribe. It is shockingly easy to administer the wrong amount of medication. If, for example, any of the health care providers in the entire medication chain (from doctor to nurse to pharmacist) misses or transposes a decimal point, the patient could be administered ten or a hundred times too much or too little medication.

Different medications have to be administered in different ways. For example, if the medication is to be administered by shot, the nurse might give the shot in the wrong place. Different drugs have to be injected into the body in different places. For example, some drugs must be injected in muscles, while others have to be injected directly into the bloodstream. Failure to administer the medication in the proper manner in this case would likely make the nurse liable in a lawsuit.

Physicians and nurses can also be held liable for bad handwriting. Nurse has probably heard about doctors’ notoriously poor penmanship. But bad handwriting on prescriptions is a serious matter. If the pharmacist misreads the prescription, the patient will receive the wrong medication, and whoever wrote the prescription is going to be held liable. Luckily, this type of negligence is fading away as many health care providers are now switching to electronic prescriptions, in which the prescription is sent electronically directly to the pharmacy.

RNs had different types of experienced roles in prescribing events and in documenting medications. Mainly RNs experienced their role as substantial in prescribing events. In documenting prescriptions, RNs cited physicians as being accountable for the documenting process and RNs being accountable for programming administration times in accordance with the unit’s policies. Being responsible for the whole documenting process was experienced as extremely time consuming, slow, and a task demanding accuracy, especially as orders are occasionally equivocal and ambiguous.

The problems RNs experienced in prescribing were related to prescriptions, admissions, or discharges. Prescription-related problems included equivocal and erroneous prescriptions, nonprescribed orders, crucial factors not taken into account, and lack of information. Equivocal prescriptions consisted of telephone and verbal orders (e.g., mentioned when bypassing), including both incomplete prescriptions (e.g., missing strength/dose/dosing/formulation) and unclear order expiration dates (real time with last administration versus the printed medicine chart in the medicine room). RNs also experienced prescription process complicated when physicians documented medications to a wrong place in the software. That is why it was sometimes difficult for the nurses to notice new or changed prescriptions. Erroneous prescriptions comprehend errors in prescribed medicine strength or dose and prescriptions that were documented erroneously (e.g., PRN medicines prescribed to scheduled medications). Nonprescribed orders, meaning prescriptions that should have, but had not, been implemented by physicians (e.g., premeditations or medicines on hold that should be prescribed to continue), were experienced as problematic. Prescriptions were also experienced as difficult when crucial factors, such as interactions of prescribed medicines with patients’ other medications and duplicate orders, were not taken into account, or when RNs were uninformed of new prescriptions. Verifying the correctness of medication administration records (MARs) at admission or discharge was experienced as problematic and time consuming. It was confusing for RNs to find out patients’ currently active medications, latest updates, and the expiration dates of each medicine: “…every time a new patient arrives in the unit, you need to print the patient’s medicine chart and find out if it’s accurate…you’re finding out what medicines the patient is actually taking, what dosage and when…” or “…when discharging a patient nobody goes through the patient’s whole medication list…nurses are the ones asking what about this and that medicine….”