Maybe a dumb question about physician errors

[DolceVita, ADN, BSN, RN]

To those of you who have experience...I am not far enough into my nursing education to know the answer to this:

If a physician gives/writes orders for a medication which are wrong (med is contraindicated, wrong dose etc.) the nurse is supposed to catch this. If the nurse doesn't catch it, are both the nurse and the physician subject to the same disciplinary action?

I am thinking the answer is no.

[Virgo_RN, BSN, RN]

I think it probably depends upon the nature of the error. As the person who is administering the med, it is the nurse's responsibility to know whether the dose is appropriate and whether the drug is indicated, as well as whether the patient has any listed allergies to the drug or is taking another drug that might interact. If, considering all of these things, the med order makes sense, and the nurse gives it, I don't think s/he would/should be held responsible if it turns out to be an erroneous order. However, if something about the med order doesn't make sense and the nurse gives it anyway without getting clarification from the prescriber, then they would be held accountable.

[HouTx, BSN, MSN, EdD]

Nursing scope of practice is defined by each state's nurse practice regulations/laws. In Texas, we have a legally defined "Nurse - Patient" duty that would require the RN to take action on behalf of the patient.

[roser13, ASN, RN]

I agree with Virgo. If you give it, you and the prescribing MD have issues.

If you don't give it, only the MD has issues.

[DeepFriedRN]

I agree with Virgo. If you give it, you and the prescribing MD have issues.

If you don't give it, only the MD has issues.

Actually, if you don't give it, nobody has issues...Because you will have called the ordering MD and clarified, thereby obtaining the correct dose/med/etc. So it will be no harm, no foul. If, however, you give it, you are hosed, because it's part of our scope to know better. And the MD probably still won't have issues, because he will say that you (the RN) didn't tell him that the pt had an allergy/was on contraindicated med/etc. So naturally, it's our fault. Again. :icon_roll

[rn/writer, RN]

If the nurse catches the error, no harm-no foul, as far as the patient is concerned. But I would still bring this to the attention of the charge nurse or unit manager. Single mistakes here and there, especially if they are comparatively minor, might not be a cause for alarm. But if an error is such that it could have caused serious harm, or if there is a pattern of unsafe practice, the unit manager can take this information to the chief resident or whomever oversees the attendings and share the concerns.

I would also report any attitude received from an offending doc, although one would hope there would be a gracious response and maybe even a bit of gratitude for saving their anatomy.

[Daytonite, BSN, RN]

nurses are disciplined through the hospital administration following rules, policies and procedures that are in place for the employees of the facility. most physicians are not employees of the hospital and only have privileges to practice. they are self-disciplined and the mechanism for any disciplinary action against them is separate from the same mechanism that disciplines the nursing staff. that is by state law in all states. the practice of the doctors is monitored by the executive medical committee. if a doctor does something wrong the chief of the service under which the doctor practices needs to be notified by sending a note to the medical staff office. it is up to the service chiefs to address any wrong doing with individual doctors. they can also be put under peer review when something serious goes wrong and they are called before a group of their fellow doctors to answer for their actions. this is a medicare and jcaho mandated activity.

[lamazeteacher]

I agree with the above posts, but wonder why no one suggested calling the MD to question his/her order (nicely). It could be that it had been a very busy day, and he/she was thinking of a different patient for whom the order might have been appropriate. I've found that nurses fear confrontation with a physician who may be gruff and could turn oppositional. In that case, the most senior nurse, NM, supervisor should definitely call that physician to question the order, and he/she would probably commend the nurse who caught the error. Never give a medication you question, until its use has been sanctioned by a pharmacist or the doctor who heads the department where you work.

As far as punitive measures that could be taken against you and/or the doctor, if you gave the medication that would depend on thye damage done. No lawsuit will reach a hearing unless there has been damage to a patient, now or even much later. However, with or without harm done, just the fact that a nurse gave a drug which she thought inappropriate in any way, she would be open to disciplinary measures. When I was in nursing school, one of my classmates gave the wrong patient Milk of Magnesia. She was suspended for 3 months, and almost didn't graduate with us.

I'd love to know what prompted your OP, and how you feel about the responses.....

[rn/writer, RN]

I don't think anyone is suggesting not calling the doc. But sometimes further action might be needed if problems are serious enough or if they are on-going or if there is a bad attitude on the part of the doctor. It shouldn't be only the nurses who are held accountable.

Approaching prescribing errors as a learning opportunity is good and may be all that is necessary. But if the situation isn't resolved at this level, additional steps are warranted. Nurses are not directly involved in this system, but without their input and notification, the powers that be will have no way of knowing that there are problems. That is why I encouraged telling the unit manager so she can inform authority figures on the medical side that mistakes are being made. Again, this would be after repeated errors, a very serious mistake, or a hostile attitude.

I understand that a doc can be distracted or having a bad day, but nurses are subject to all kinds of stressors. If we make a med error, we can very easily get written up, and it's not too likely the doc will step in and say, "Give her a break. She was really tired." I don't have it in for docs. I just think they should be held as accountable as we are.

[diane227, LPN, RN]

You are responsible for knowing the medication and the normal doses and in a court of law you will be held accountable if you give a drug that is the wrong dose. Just because the doctor wrote it does not mean it is correct. At our facility, this is how we deal with this issue:

1. We use a medication list at the time of admission to list what medications the patient is on, the dose and the route. The nurse collects this information upon admission.

2. If the patient does not know what medications they are on, we try to contact family or pharmacy to get a list.

3. Upon admit, the doctor sees the patient and reviews the medication list and checks the things that are needed, changed or deleted.

4. We scan this list to the pharmacy along with other orders.

5. If a dose is not correct, pharmacy either calls the nurse or the doctor.

6. If possible we clarify the dose with the patient and write a clarification order.

7. If it is a new drug, we call the doctor to clarify.

8. Pharmacy has auto sub's for many medication and will make the correction on the MAR according to pre approved guidelines.

9. There are some situations that I, as charge nurse, can correct on my own, depending on the situation. I have certain relationships with certain physicians and they have told me what they expect. I can make changes in certain orders, depending on the type of medication. For example, they may order Zofran Q4 hours and it can only be given Q8 hours. So I write the correction/ clarification and send it to the pharmacy.