In past years, nurses were frequently instructed to interrupt the process of administering medications to numerous patients in order to assist a physician. In most cases, the assistance required by the physician was non urgent in nature, more closely resembling services that could have been easily provided by a handmaid. A physician ordering a nurse to obtain a patient's paper chart and hand it to him/her is just one example of such a non urgent demand that resulted in an unnecessary interruption of the patient care process.
As a Certified Legal Nurse Consultant, I am frequently called upon to review medical records for potential litigious merit in situations where patient injury has resulted from an apparent medication administration error. There are several areas that require special attention during the course of such a review.
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Although frequently overlooked, it is essential to conduct a review of the staffing records for the unit where the incident occurred.
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This review should encompass a time period of approximately 30 days prior to and 30 days following the alleged medication error.
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Did the incident occur on a weekend or holiday when staffing is typically at is leanest?
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Did the incident occur on a shift when staffing is typically less e.g. evening or night shift?
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Did the incident occur while several members of the nursing staff were on vacation - especially nursing managment personnel?
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Was the nurse working the unit to which he/she was typically assigned?
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Had he/she been "floated" to an unfamiliar unit?
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Was he/she an "agency" nurse?
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If a "float" or "agency" nurse, what unit-specific orientation was provided prior to his/her assumption of patient care duties?
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Was any resource person available to answer questions or address the patient care concerns of a nurse who was unfamiliar with the unit?
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Was such a resource person physically accessible or only available via telephone or other electronic means?
"Where do you keep the syringes here?"
In my experience as a nurse, I have observed that interruptions in the medication administration process are more likely to occur when there is insufficient staffing and/or a nurse is working a unit with which he/she is unfamiliar. Inadequate staffing, agency staffing and floating of staff members to other units are ongoing issues that are especially frequent struggles within the long term care arena.
Interruptions take place when the unfamiliar nurse must leave the medication administration process in order to locate the necessary supplies to carry out the physician's orders. Furthermore, the unfamiliar nurse must locate a resource person to discover the storage location for supplies on the unit before returning to the medication administration process.
A combination of inadequate staffing and a nurse who is unfamiliar with the unit increases the opportunity for a medication error to take place. Medication errors possess the ability to render devastating, life altering consequences for the patient - even unto death.
INADEQUATE STAFFING
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INTERRUPTIONS IN MEDICATION ADMINISTRATION PROCESS
LEADS TO
♦♦INCREASED RISK FOR PATIENT INJURY♦♦
"Legal Issues in Perioperative Nursing" article composed by Julie R. Gunn RN, CLNC published in national nursing magazine.
OR Nurse 2010 (July 2010 vol. 4 number 4 pp. 35 - 39) contains Julie's first nationally published article regarding the legal aspects of nursing. The article titled "Legal Issues in Perioperative Nursing" details the legal elements required for a potential malpractice case to be considered meritorious.
Appropriate, accurate documentation is emphasized as the nurse's best defense. It is a well known fact that a large number of nurses depend upon the insurance coverage of their employer to provide for their nursing malpractice defense. Within this article, Julie was privileged to explain why a nurse's total dependance upon the malpractice insurance coverage of an employer is ill advised. All nurses are strongly encouraged to obtain personal nursing malpractice insurance coverage.
Excited to share her knowledge, Julie is looking forward to submitting future articles regarding legal aspects of the provision of medical and nursing care.
