There was a time when nurses were not included in malpractice and negligence lawsuits, but that is no longer true. Today, nurses are included with doctors, hospitals, and other healthcare providers and agencies when the outcomes of patient treatments are undesirable. When a nurse is accused of failure to competently perform her or her responsibilities to the patient and employer, the result may be as serious as the death of the patient. For this reason, focus has centered on the types, incidences, and ways to prevent actions that cause patients harm and may result in expensive and license-threatening litigation for a nurse and other providers.
Malpractice, Negligence, and Medical Errors
Based on information reported by the Centers for Disease Control and Prevention, medical errors constitute the third major cause of death related to healthcare, surpassed only by heart disease and cancer (see Graph 1)(Makary and Daniel, 2016). One definition of a malpractice is “a commission or an omission with potentially negative consequences for the patient that would have been judged wrong by skilled and knowledgeable peers at the time it occurred, independent of whether there were negative consequences (Wu, Cavanaugh, McPhee, Lo, & Micco, 1997, p. 770). This may be interpreted to also be a decision that does not achieve the outcome intended. On the other hand, although medical negligence is often used synonymously with medical malpractice, negligence may only be one aspect of a claim of malpractice. Therefore, one definition of medical negligence may be “An act or omission (failure to act) by a medical professional that deviates from the accepted medical standard of care” (Goguen, 2017).
Graph 1. Statistics on Health Related Death in the U.S. compiled from information reported by the Centers for Disease Control and Prevention (Makary & Daniel, 2016)
A study by Nanji, Patel, Shaikh, Seger, and Bates (2016) focused on medical errors; the researchers defined a medical error as a failure to accurately complete medication administration or adhere to a patient care plan. The study involved the perioperative area of an academic medical center with 1046 tertiary care meds. More than 40,000 operations were performed every year in 64 operating rooms. A total of 227 surgeries were observed with 3671 medication administrations; a total of 193 (95 percent were deemed to involve a medical error and/or an adverse drug event with 79.3 percent considered to be preventable. The researchers concluded that one out of every 20 medication administrations included a medical error and/or an adverse drug event and are significantly higher than those estimated by previous surveys.
These three cases are examples of the consequences for all stakeholders concerned when a nurse commits malpractice and negligence. Facilities have the ability to institute policies and guidelines that assist in the prevention of these medical errors.
Proposed Guidelines
While there are no guarantees that instituted policies and guidelines will prevent medical errors on the part of employees, consistent review and quality assurance programs may reinforce the education all nurses receive in the course of their training (Reising, 2012).
The failure to follow standards of care may result in allegations of not following protocols or instructions, resulting in a claim of negligence. Prevention includes only performing skills within the scope of training and experience. Nurses should know their limitations and not accept assignments they are not competent to perform. Inservice training should regularly review the state’s nurse practice act and the policies of the facility.
Nurses may find themselves taking on the operation of equipment without proper training. To avoid legal action in the event of patient hard, they should inform a supervisor of the deficit prior to use of unfamiliar equipment until properly educated. Quality control departments should be sure inservice training takes place for all staff in equipment operation prior to use.
Whether the facility uses electronic, paper, or a combination of methods for documentation, it is vital for nurses to document every aspect of patient care, including conversations between staff members. If there is no documentation, the court will say it did not happen. The nursing process should be used and charting should never be performed prior to the action documented.
Monitoring a patient relies not only on orders and facility policy, but on patient’s status and the nurse’s judgment, instincts, and experience. Failure to adequately monitor and assess the needs of the patient experience as often as needed may result in inclusion in a lawsuit. Sufficient documentation of times and assessments are important, but so also is communication with the doctor of potential problems.
The claim of a failure to communicate is often present in medical malpractice lawsuits. The exchanges include between the nurse and the patient, the doctor, or any other healthcare provider. Prevention lies in proper documentation related to the care of the patient and changes discovered in the course of monitoring and assessment. This topic is also important for continuing education and frequent quality control monitoring.
Conclusion
Humans make mistakes, but in the nursing profession it is crucial to prevent as many of them as possible. Through the judicious use of judgment and adherence to regulations, laws, and facility policies, medical errors should be kept to a minimum. Subsequently, patient harm and resulting lawsuits claiming medical malpractice and negligence should also be infrequent.
References
Findlaw.com. (2005). FindLaw's Court of Appeals of Texas case and opinions. Findlaw. Retrieved 26 January 2017, from http://caselaw.findlaw.com/tx-court-of- appeals/1158723.html
Goguen, D. (2017). Medical Negligence: The Law Explained - AllLaw.com. AllLaw.com. Retrieved 26 January 2017, from http://www.alllaw.com/articles/nolo/medical- malpractice/negligence.html
Makary, M. & Daniel, M. (2016). Medical error—the third leading cause of death in the US. BMJ, i2139. http://dx.doi.org/10.1136/bmj.i2139
Nanji, K., Patel, A., Shaikh, S., Seger, D., & Bates, D. (2016). Evaluation of Perioperative Medication Errors and Adverse Drug Events. Anesthesiology, 124(1), 25-34. http://dx.doi.org/10.1097/aln.0000000000000904
NJLawjournal.com. (2013). Recoveries of $1 Million or More. New Jersey Law Journal. Retrieved from http://www.njlawjournal.com/id=1202622011244/Recoveries-of-1- Million-or-More
NYCourts.gov. (2014). Doe v Guthrie Clinic, Ltd. (2014 NY Slip Op 00138). Nycourts.gov. Retrieved 26 January 2017, from http://www.nycourts.gov/reporter/3dseries/2014/2014_00138.htm
Reising, D. (2012). Make your nursing care malpractice-proof. American Nurse Today, 7(1). Retrieved from https://www.americannursetoday.com/make-your-nursing-care- malpractice-proof/
Wu, A., Cavanaugh, T., McPhee, S., Lo, B., & Micco, G. (1997). To tell the truth. Journal of General Internal Medicine, 12(12), 770-775. http://dx.doi.org/10.1046/j.1525- 1497.1997.07163.x
