NARRATOR [continued]: such as the American Nurses Association, ANA; specialty-nursing organizations, such as the Association of Preoperative Registered Nurses, AORN, and American Association of Critical Care Nurses, AACN; authoritative nursing texts and journals;
NARRATOR [continued]: your own institution’s policies and procedures manuals; and published court cases involving similar circumstances. Many times, health care providers are informed that there are policies and procedures but fail to take the time actually, to review and understand them.
NARRATOR [continued]: Policies and procedures are commonly used in negligence claims. Standards of care can be variable and can change on a yearly, or even monthly, basis. With that said, nurses have been sued for such things like failing to follow a fall protocol; failing to follow procedures for a specific skill,
NARRATOR [continued]: such as administering medications or inserting a nasogastric tube; or failure to make use of equipment correctly or responsibly. If you have set up equipment for anything other than a manufacturer’s intended purpose, or against policy and procedure, you could be liable. You could also be sued for malpractice for using equipment that you’re not familiar with
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Page 3 of 9 Nursing Negligence: Guidelines for Care
NARRATOR [continued]: or haven’t been trained to use.
NIKKI LIND: You follow your orders. They’re there for a reason. Those things are in place because we’ve ironed out the kinks. They figured out what we need to do, and that’s why we do what we do. We need to follow those procedures. We follow our orders sets. You have lots of education when you’re in those areas, as well, why we’re doing what we’re doing,
NIKKI LIND [continued]: and that’s why they’re important because there could be bad outcomes. And we never want that to happen.
NARRATOR: The second legal element of negligence that must be proven is that you breached your duty to the patient.
HEALTH CARE PROVIDER: We’ll be gone for just a little bit. Call us if you need something, OK?
PATIENT: All right.
HEALTH CARE PROVIDER: OK.
NARRATOR: A breach is any act that falls below the standard of care. The breach may be by an act or failure to act, Either giving care in an unsafe manner or omitting necessary care. A breach of duty may also be an error in assessment or planning that causes damage to the patient.
HEALTH CARE PROVIDER: OK, look straight ahead. Head up.
NARRATOR: An assessment error, for example, might be as simple as improperly gathering information or not monitoring a patient’s condition as frequently as needed. Or a breach may involve more complex issues of judgment, such as not recognizing the significance of a symptom, or a change in the patient’s condition,
NARRATOR [continued]: or not communicating this effectively to the physician or your supervisor. An assessment error or breach can be not reporting, in a timely manner, critical values, vital signs, assessment findings, and lack of results for medications or interventions.
NARRATOR [continued]: A planning error might be developing an inadequate patient care plan that fails to address one of the patient’s needs. For example, a planning error occurs when a care plan for a bedridden patient does not include enough repositioning. This places the patient at risk for pressure sores and blood
NARRATOR [continued]: clots. The third element of negligence that must be proven is that your breach of duty caused injury or damages to the patient. It is important to recognize that it isn’t necessary for your action to enforce the patient to sustain an injury.
NARRATOR: An action or omission that simply allowed it to happen is enough. For example, if you are caring for a patient in a post-op unit who has received medications that caused disorientation or confusion, as in this scene, and you leave the bed rail down, you have created a condition
NARRATOR [continued]: that makes it foreseeable that the patient could fall out of bed. Even if other factors contribute to the patient’s injury, as long as your breach of duty was a substantial causative factor, it is enough under the law. The fourth element of negligence that must be proven is that there was actual harm to the patient.
NARRATOR [continued]: Some injury or a worsening of the patient’s condition must occur as a consequence of your breach of duty. In this case, the actual harm of the arm injury is a direct consequence of the fall.
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Page 4 of 9 Nursing Negligence: Guidelines for Care
DANIEL GIROUX: And there’s a lot of things that go into that. When you’re talking about, what’s their personal exposure, well, it depends on the potential harm to a particular patient. Obviously, more harm, a debilitating injury that is a life-sustaining injury that’s going to require a medical expense for the remainder of their life–
DANIEL GIROUX [continued]: typically the higher those types of cases will draw in terms of a verdict or some type of settlement. So you’ve got to balance that with what level of insurance do they have? What are their limits on their policy? And if they have a policy that is not high enough, then potentially, they can expose their personal assets.
WOMAN: Well, not specifically. It’s been quite a while ago.
NARRATOR: If all of these conditions are proven in court, the patient can recover what are called “compensatory damages.” These are monies that are meant to compensate the patient for the cost of care, lost wages, and pain and suffering. In rare cases, if the negligence was especially reckless,
NARRATOR [continued]: some states allow patients to be awarded punitive damages as well to punish the reckless caregiver. Many insurance policies do not cover punitive damages, and a caregiver may be personally liable for them.
DANIEL GIROUX: I’ve had a case against a facility here in the Midwest where a nurse was required to follow standard postpartum orders. Within an hour after any type of delivery, that is when a mother is more likely to have a hemorrhage. And in that particular case, for the first 20 minutes,
DANIEL GIROUX [continued]: every five minutes, you’re checking vitals, and every 10 minutes, and every 15 minutes. And it’s pretty standard throughout the United States what they’re supposed to do. But in this particular case, the nurse wasn’t checking vitals for an hour. And ultimately, what happened when she finally decided to check the vitals, unfortunately, the patient was very hypotensive.
DANIEL GIROUX [continued]: Her blood pressure was 80 over 40, she had a heart rate of 140, and she was in a late-stage hemorrhage, and she ended up passing away. And in that case, it was just a matter of had the vital signs have been properly recorded when they were supposed to and brought to the attention of the physician, there’s things at the early stages of hemorrhage, that could have been done to abate the ultimate problem
DANIEL GIROUX [continued]: and the death in that particular case.
NIKKI LIND: Well I actually used to work in labor and delivery. And so it’s highly important, especially in that area, you’re doing vitals, and fundal checks, and everything you’re supposed to do. And if you don’t do it, that’s one of the scary stories that could come about. And you just follow your orders.