Medication Errors in Nursing: When a Mistake Becomes a Malpractice Lawsuit

The administration of medication is a cornerstone of modern healthcare, yet it’s a process fraught with potential pitfalls. Nurses, as the primary caregivers responsible for dispensing drugs, are often the last line of defense against medication errors. But what happens when a mistake occurs, and when does that mistake cross the line into nursing malpractice, potentially leading to a lawsuit?

Medication errors are a surprisingly common occurrence in healthcare settings. An estimated 237 million medication errors occur in England annually. These errors can range from minor oversights with little to no impact on the patient to severe mistakes that result in significant harm or even death. In the U.S., medication errors harm at least 1.5 million people every year. The extra medical costs of treating drug-related injuries occurring in hospitals alone are at least $3.5 billion a year. When these errors are a result of negligence, a malpractice lawsuit may be warranted.

What Constitutes a Medication Error?

The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.” This broad definition encompasses a wide range of mistakes, including:

Incorrect Dosage: Administering a dose that is higher or lower than prescribed.
Wrong Medication: Giving the patient a medication different from what was ordered.
Improper Timing: Administering medication at the wrong time, either too early or too late.
Wrong Route of Administration: Giving the medication through a different route than prescribed (e.g., oral instead of intravenous).
Failure to Account for Allergies: Administering a medication to which the patient is known to be allergic.
Incorrect Preparation: Failing to properly prepare a medication before administration.
Failure to Document: Not properly documenting the dispensing of drugs.
Medication Given to the Wrong Patient: Providing medication to the incorrect patient.

Common Causes of Medication Errors

Medication errors rarely stem from a single cause. Instead, they are often the result of a complex interplay of factors, including:

Workload and Staffing: High patient-to-nurse ratios and understaffing can lead to fatigue and decreased vigilance.
Communication Breakdowns: Poor communication between doctors, nurses, and pharmacists can result in misunderstandings and errors.
Lack of Knowledge: Insufficient knowledge of medications, dosages, and potential side effects can contribute to errors.
Distractions and Interruptions: A busy and chaotic work environment can lead to distractions and interruptions, increasing the risk of mistakes.
Similar Drug Names or Packaging: Medications with similar names or packaging can be easily confused.
Systemic Issues: Flaws in hospital policies, procedures, or technology can create opportunities for errors.
Inadequate Training: Insufficient training on medication administration protocols and procedures.
Memory Lapses: Momentary memory lapses by nursing staff.

When Does a Medication Error Become Malpractice?

Not every medication error constitutes malpractice. To establish nursing malpractice, the following elements must be present:

Duty of Care: A nurse has a legal duty to provide competent care to their patients, which includes administering medications safely and accurately.
Breach of Duty: The nurse’s actions must have deviated from the accepted standard of care. This means that the nurse failed to act as a reasonably prudent nurse would have acted under similar circumstances.
Causation: There must be a direct causal link between the nurse’s breach of duty and the patient’s injury. In other words, the medication error must have directly caused the patient’s harm.
Damages: The patient must have suffered actual damages as a result of the injury, such as medical expenses, lost wages, pain, and suffering.

Legal Consequences for Nurses

When a nurse makes a medication error that results in patient harm, the legal consequences can be significant and multifaceted. These may include:

Disciplinary Action by the State Board of Nursing: A state board may reprimand, suspend, or even revoke a nurse’s license to practice.
Job Dismissal: A nurse may be terminated from their employment.
Civil Lawsuits: A nurse may be sued for negligence, and be required to pay monetary damages to the injured patient.
Criminal Charges: In cases of gross negligence or intentional misconduct, a nurse may face criminal charges.
Mental Anguish: The emotional distress and psychological impact of committing a medication error can be substantial.

Defenses Against Medication Error Lawsuits

Healthcare providers and their insurers often employ robust defense strategies to counter medication error claims. These defenses may include:

No Breach of Duty: Arguing that the nurse’s actions did not fall below the accepted standard of care.
Lack of Causation: Claiming that the medication error did not directly cause the patient’s injury, or that the injury was due to an underlying medical condition.
Contributory or Comparative Negligence: Asserting that the patient contributed to the error, for example, by providing inaccurate health information or failing to follow instructions.
Assumption of Risk: Arguing that the patient understood the risks of the medication and agreed to take it anyway.
Expired Statute of Limitations: Claiming that the lawsuit was not filed within the time limit set by state law.

The Role of Expert Witnesses

Expert witnesses play a crucial role in medication error lawsuits. These witnesses, who are typically experienced healthcare professionals, can provide specialized knowledge and insights to help the judge or jury understand the complexities of the case. Expert witnesses can:

Define the Standard of Care: Explain what a reasonably prudent nurse would have done under similar circumstances.
Establish Breach of Duty: Testify whether the nurse’s actions deviated from the standard of care.
Prove Causation: Explain the link between the medication error and the patient’s injury.
Assess Damages: Provide an opinion on the extent of the patient’s damages.

Preventing Medication Errors

Preventing medication errors is paramount to protecting patient safety and reducing the risk of malpractice lawsuits. Strategies to prevent medication errors include:

Following the “Five Rights” of Medication Administration: Ensuring the right patient, right drug, right dose, right route, and right time.
Using Technology: Implementing electronic health records (EHRs), barcode medication administration (BCMA) systems, and computerized prescriber order entry (CPOE) systems.
Improving Communication: Encouraging open communication between healthcare providers, and involving patients in their care.
Reducing Workload and Fatigue: Ensuring adequate staffing levels and providing nurses with sufficient rest.
Providing Education and Training: Offering ongoing education and training on medication safety and administration protocols.
Creating a Culture of Safety: Fostering a work environment where errors can be reported without fear of punishment.
Double-Checking Medications: Using independent double checks for selected high-alert medications.
Learning Proper Medication Administration Guidelines: Following the medication administration policies, regulations and guidelines.

Seeking Legal Assistance

If you or a loved one has been injured due to a medication error, it is important to seek legal assistance from an experienced attorney. A lawyer can help you understand your rights, investigate the circumstances of the error, and pursue a claim for damages if appropriate. Similarly, nurses who are facing allegations of malpractice should seek legal counsel to protect their professional interests.

Conclusion

Medication errors in nursing can have devastating consequences for patients and can lead to complex and challenging malpractice lawsuits. By understanding the causes of medication errors, the legal standards for nursing malpractice, and the strategies for preventing errors, healthcare professionals can work to protect patient safety and minimize the risk of legal liability.