Who is responsible for error?

[crnasomeday]

As a nursing student I am not yet sure of all the legalities regarding malpractice responsibility. At a community hospital in my town, a 13 year old girl died recently from fluid overload. The doctor in the ER misread her lab results, and the paper reported that he thought she was two pints low on blood. In school we have learned that we hold a great deal of responsibility when administering meds and IVF, and that even if the mistake is due to Dr.'s error, we can also be held responsible. In this case, do you think that would be true? Could the nurse who initiated IV fluids be held liable for the Dr.'s mistaken interpretation of the labs?

[fergus51]

Here the stansard is : would a prudent nurse have done what this nurse did? I would hope a nurse would question an order that they should know could cause death. IF they don't they're liable. Did the nurse not see the lab results? The specifics would tell you if a nurse is liable or not.

[egmillard]

A part of a nurses practice is the interpretation of lab results, and there implication on patient care. However, the doctor is primarily responsible for the patient's care, it is the responsibilty of the nurse to be accountable for his/her actions. Therefore we should always question any doctors order, we just dont have to say it out loud. We should always think twice. Just in case something goes wrong. However, this is hard when you are just too damn busy, but always stop to think.

[MollyJ]

I have had the pleasure of doing chart review for a defense malpractice attorney in the past. My advice is please do not second guess this case. Who knows what happened. You're not likely to find out by reading the paper.

In your practice you will get orders from doctors that make good sense, those that make no sense until you have some more contextual information, and those that make no sense and should not be instituted. The lines between those are not always clear.

One of the things I worry about the most is how malpractice concerns often set up adversarial lines between doctors and nurses and those doc and nurses in other hospitals and communities. As a professional, the best thing that you can do is to say, "I surely wasn't in their moccasins that day. I do not fully understand the situation. I will have to have faith in the quality review process and the legal system to allow people who are fully informed of the situation to decide if something avoidable or gross happened." In health care situations, none of us are omniscient and we can only have the information available to us on which to act.

My condolences go out to the family. My heart felt concerns go out to the professionals involved.

[This message has been edited by MollyJ (edited February 24, 2001).]

[Zee_RN, BSN, RN]

In this case, I'd have to imagine if the nurse did not have access to the proper lab values and was following doctor's orders, she would not be liable. If she did, in fact, have access to the girl's H&H, she MAY have some liability exposure but I can't imagine it would really stick, esp. in an Emergency Situation...the doc said "2 UNITS PRBC NOW!" and she gave it.

You always can question doctor's orders. My patient this week had an H&H of 10.7/32.1 and the oncologist had ordered a unit of PRBCs. I couldn't imagine why...the patient's H&H had been stable for days at this value. I checked his progress note and he had written that the pt's H&H was 8.5/28 (which was his H&H four days ago). I called him and he was amazed he had missed that (read the wrong column on the weekly lab sheet) and rescinded his order. (of course, be aware this was not an emergency situation--the doctor had written the order at 7AM and I was not able to reach him until 2PM!)

[Mijourney]

Hi crnasomeday. I agree with the previous posters. I do feel, though, that your example illustrates:

1. The need for proper staffing in response to patient acuity and numbers.

2. The need for more nurses at the bedside.

3. The importance of nurses to understand that our role in patient care is not simply following doctor's orders or blindly following hospital policy or lack thereof.

We as nurses need to be able to demonstrate exceptional critical thinking skills within our scope of knowledge. We need to learn wisdom on when to question situations and when to let it go. As one poster pointed out, time and other constraints unfortunately do not allow us to shine like we know we can or should.