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?

[Ruby Vee, BSN]

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

that's my line, you plagerist you!

[BabyLady, BSN, RN]

I agree that it would depend on the situation and it's not that cut and dry.

Granted, a nurse would only be administering the medication if the patient was in the hospital.

If that is the case, then the pharmacist would know all of the meds being taken during the hospitalization...the pharmacist also approved the combination.

There are some combinations/doses that should be obvious to nurses and some that are not. It would depend on the drug and the situation.

Also, I was floated to another unit recently, and when I walked into the room, a patient had a prescription bottle and was withdrawing a pill and grabbed something to drink, I asked her which med she was taking, she told me and proceded to swallow it.

When I checked our medication administration system (that is supposed to list home meds as well), that med was not listed...I asked her if she told someone when she was admitted about her home med and she said she did not. She said she didn't want to tell anyone because she had enough pills for her hospital stay and didn't want to be charged for the pills when she had already paid for her script.

Depending on the situation, a good attorney could argue the case either way.

[cherrybreeze, ADN, RN]

yes..... we just finished a class on it....both the doctor and licensed nurse are both responsible...

there is a similar case on this http://www.thefreelibrary.com/Did+RN+have+duty+to+question+discrepancy+in+discharge+order%3F-a0143063248

it is where a doctor didnt write an order for plavix on a guy in 2006 who had coronary stents placed....the nurse saw the discharge order, and didnt question the absence of plavix..the man went home..coronary stent occluded..he survived and he sued the hosp and the nurse....

This example to me (I didn't read the link, just using the summary posted here) is al ittle different. I don't think a med that isn't prescribed in the first place falls in to the same category as administering what is already prescribed. The nurse doesn't know if the physician has a reason for not prescribing it, for one (although no, it can't hurt to ask, and if it was a med I knew to be ordered routinely I probably WOULD ask). I don't think I would know that ordering Plavix was a given after coronary stents (I just don't take care of patients that have them done...does it seem reasonable that it's prescribed, yes, but I wouldn't have known it's ALWAYS done).

I hope I'm explaining myself well enough. And kudos those who also called out the pharmacist, I was going to add that, too.

[LVSisa]

We were thought in nursing school that the one who gives the drugs carries all the responsibility. That means the nurse is responsible for this.

[bluemorningglory]

I think that the doctor-who has more education and earns more-is responsible

[fiveofpeep]

well lets say the nurse gave nifedipine, metoprolol, morphine, and sildenafil all at once to someone starting out with a low bp or on a nitroglycerin drip and then the patient bottoms out and dies...I would say the nurse is at fault because when the MD prescribed that med, he or she did so without the ability to foresee the future blood pressures. It's the nurse's discretion to hold the med accordingly and not just give a combo of bp dropping meds to a hypotensive patient.

this is the situation Im thinking could have happened but like others said, we dont know the details.

[Pepper The Cat, BSN, RN]

Pt ordered Ativan PRN, Serax PRN and Tyl # 3 PRN.

Nurse gave all at that same time on night, because the night before the pt was awake alot and rang the bell too much.

Pt was so unresponsive the next day that the day shift had to start and IV for hydration. MD on call that day d/c some of these meds.

Who is at fault?

The doctor ordered the meds.

The nurse gave the meds.

[kcochrane]

Pt ordered Ativan PRN, Serax PRN and Tyl # 3 PRN.

Nurse gave all at that same time on night, because the night before the pt was awake alot and rang the bell too much.

Pt was so unresponsive the next day that the day shift had to start and IV for hydration. MD on call that day d/c some of these meds.

Who is at fault?

The doctor ordered the meds.

The nurse gave the meds.

In this case the nurse. The MD gave the nurse the tools to help the patient. She should have started with one and saw how that worked. But to give them all at once not knowing how they would be tolerated and based on them being awake the night before?? No nursing judgement used here IMHO.

[iPatch]

I am not sure whether my inability to draw a clear answer regarding this query can be attributed to my lack of familiarity with the topic in question.

One thing I do know, what I'm reading here resembles the proverbial modern-day witch hunt.

The majority is blaming all individuals involved -- patient, nurse, pharmacist, and doctor -- and does so with such alarming finality without ever questioning whether the system failed.

I honestly believe such incident can be prevented if hospitals, for instance, can impose an effective means that will force personnel to do redundant checks concerning drug reactions.

[BabyLady, BSN, RN]

This example to me (I didn't read the link, just using the summary posted here) is al ittle different. I don't think a med that isn't prescribed in the first place falls in to the same category as administering what is already prescribed. The nurse doesn't know if the physician has a reason for not prescribing it, for one (although no, it can't hurt to ask, and if it was a med I knew to be ordered routinely I probably WOULD ask). I don't think I would know that ordering Plavix was a given after coronary stents (I just don't take care of patients that have them done...does it seem reasonable that it's prescribed, yes, but I wouldn't have known it's ALWAYS done).

I hope I'm explaining myself well enough. And kudos those who also called out the pharmacist, I was going to add that, too.

I agree with this....because a nurse is only responsible for medication ordered to be administered, he/she isn't responsible for the woulda, shoulda, coulda.

In the NICU, sometimes the MD's order Lasix after blood transfusions and sometimes they don't...once I worked in the NICU I ask...but as of yet, haven't figured out why they do on some, and why they don't on others.

[BabyLady, BSN, RN]

Pt ordered Ativan PRN, Serax PRN and Tyl # 3 PRN.

Nurse gave all at that same time on night, because the night before the pt was awake alot and rang the bell too much.

Pt was so unresponsive the next day that the day shift had to start and IV for hydration. MD on call that day d/c some of these meds.

Who is at fault?

The doctor ordered the meds.

The nurse gave the meds.

No question about this situation, the nurse.

Anytime 3 meds with a sedative effect are ordered, they should be questioned...should they be given together? Were they ordered by the same physician?

It's odd in this "situation" that it is known that the nurse gave all 3 for convience....who would admit to that????

Also...if the on-call MD d/c'd the meds....why wasn't the chart updated to reflect this??? That is a nursing responsibilty.

[Pepper The Cat, BSN, RN]

No question about this situation, the nurse.

Anytime 3 meds with a sedative effect are ordered, they should be questioned...should they be given together? Were they ordered by the same physician?

It's odd in this "situation" that it is known that the nurse gave all 3 for convience....who would admit to that????

Also...if the on-call MD d/c'd the meds....why wasn't the chart updated to reflect this??? That is a nursing responsibilty.

They weren't ordered to be given all at the same time. The Ativan was q8 hr for anxiety. The tylenol for pain, the serax to help sleep. the ordering MD assumed that the nurses would know not to give all at once!

The nurse giving it saw nothing wrong with what she did - she's known for "snowing" her pts so they "sleep".

The drugs were d/c the day after this incident to prevent a recurrance. Night nurse was NOT happy with us!

Pt survived. that's the main thing.

I was just using this as an example that it isn't always the MDs fault.