patient dies from combination of drugs that doc prescribed. who is responsible?

[premedwoahs]

is the nurse who administered, or the doctor who prescribed it responsible?

& why?

[Music in My Heart]

The other party with some potential culpability is the pharmacist who dispensed the medications. They are the ones with the primary responsibility to catch prescription errors because they are the drug experts.

Doctors prescribe, pharmacists dispense, nurses administer... everybody along the chain has the responsibility to prevent errors.

[scoochy]

Good point about the pharmacist!

[belgarion]

One of my old instructors put it very plainly - One of the duties of a nurse is to keep doctors from killing patients.

[DirtyBlackSocks]

Elaborate more on the situation if you want more concrete answers - either way it's the fault of all three people, if not more, that everyone else has mentioned in this thread.

Who would take the most heat from the error? Probably the nurse.

[oramar]

So many people withhold information about what drugs they are taking. They do it on purpose because what they are taking is illegal. That is the cause of most fatal drug interactions. I wonder what percentage of patients don't ante up about what kind of stuff they are on other than legal prescriptions. I bet one third to one half isn't that far off.

[manncer]

If there was a Pharmacy involved the Pharmacist would carry blame from not knowing the interaction. There is no excuse for RX not catching this. All three are at fault.

[franciscangypsy]

The pharmacist would probably also bear part of the blame for an insane dose being sent up for a pt. Hadn't thought of that, but it makes sense.

Our pharmacy is constantly calling our floor when we have new admits to verify doses. It can be irritating at times when I'm really busy, but I'm glad that they're so thorough. They probably save many patients that way just by catching errors that the MD made when he was in a rush or when he didn't add that all-important decimal point.

[NurseAdida]

is the nurse who administered, or the doctor who prescribed it responsible?

& why?

The doctor that prescribed it and unfortunately the nurse that administered it. The reason being nurses are supposed to know their pharmacology and alert the doctors if there is a contraindication. Family members are more likely to sue the doctor and the hospital because both have "plenty" of money. The nurse could lose her license due to negligence.

[Katie5]

One of my old instructors put it very plainly - One of the duties of a nurse is to keep doctors from killing patients.

True but let's not put all the burden on the nurse now- if she knew her job description included all that, then heck, she could have gone on to medical school herself!

[TiffyRN, BSN, PhD]

Not enough information, I can think of situations where all, none, or any combination (MD, nurse, pharmacist) might be responsible.

Think if the MD knew of a previous reaction the patient didn't mention to the nurse.

Think if the nurse knew of a new assessment finding the MD wasn't aware of.

Think if the pharmacist mixed any of the meds incorrectly.

Think if the patient fails to mention to ANYONE of a previous reaction.

Or many other situations.

[~Mi Vida Loca~RN, ASN, RN]

I would blame this person doctor more because nurses dont presribe meds so in my opinion the person who write prescription is at fault here..I mean how a nurse could have possibly known such and such combination of drugs would kill a certain patient..I mean lets be realistic for a moment....the doctors are the main prescribers and they study the medicine for many years and are generally more educated (or should be) in regards to meds..Sadly,those situations happpen more often then we think..Not while ago I was taking care of a patient with a prescription drugs toxicity.I mean this lady was so bottomed out from her drugs when she came in to the hospital,with unstable blood pressure,chest pain constantly vommitting and it took some time for the doctors to realize no she is not going through aheart attack but basically was bottomed out by the drugs her primary doc presribed to her..She even mention it herself that she told numerous of time her doctor that she is taking too many drugs,scary.

We are the ones giving the drugs, it's our job to know. We don't just give drugs blindly. It might take a new nurse a little time to pick up less common things, and there might be cases you never know until something happens because the interactions are rare. But for common interactions, we should know. We are responsible to know common dosages to pick up errors, safe dosages on children to pick up on errors and so on and no nurse should ever be giving a drug she knows nothing about. I am still a student and we are taught this, we have a pyxis machine and you can look up drug info right on that, we have resources on all the laptops that go in with us to ever patient room that we can look up on. Multiple drug books in the med room and at the desk.

I didn't know, is not an excuse in the hospital nor a court of law. Again, it's a different story when it's a combo not known to cause a reaction, something you couldn't have known. But we ARE taught pharmacology in school, at least I was. If I am given an order that I know is not a safe dose and it's a drug known for a high toxicity or a narrow therapeutic range I will question it and if the Doc says don't worry about it, then the Dr. can administer the drug and put his butt on the line.

I am only speaking on this post here. Their is not enough information in the original post.

[Ruby Vee, BSN]

it depends. was the patient up front about all the drugs he/she was taking? did the physician know he was also taking drugs prescribed by another physician? did the nurse give all the drugs he was taking or did he take some at home and get some in the clinic? how about the pharmacist? why didn't the pharmacist question that combination of drugs, or was he going to several different pharmacies? in patient or outpatient?

years and years and years ago, when i was a brand new nurse i sent a patient to surgery. i gave her her pre-op demerol and vistaril im -- common practice in those days. because i was new and nervous, i had the charge nurse check my meds before i gave them. two or three hours later, i was tidying up her room and found an empty prescription bottle of valium under her pillow. from the date on the bottle, it should have had 20-25 tablets. it was empty. not surprisingly, she had a rocky operative course, crashed on the table and had a prolonged period of hypotension. her body survived; she never woke up. (i've changed the facts of this case around, but you catch my drift. the details don't matter anyway.) whose fault was the poor outcome?

was it my fault because i gave her the pre-op meds and didn't catch the empty valium bottle for three hours?

was it the nurse who admitted her and didn't take the valium away from her?

was it her husband who brought the valium to her in the hospital and didn't tell the nurse she had it?

was it the physician who precribed the valium?

was it the anesthesiologist who gave her the gas?

was it the surgeon who prescribed the pre-op meds?

was it the patient who took a whole bottle of valium without mentioning it to anyone?

was it the hospital's fault?

tough question. but you can't possibly answer it without having a lot more facts that i've given you or you've given us. good question for discussion, though.