Jonah Patel
Nurses play a crucial role in ensuring patient safety and providing care. However, patient injuries can sometimes occur due to various factors related to nursing care. These factors can include missed nursing care, medication errors, patient falls, musculoskeletal disorders, and workplace violence. Missed nursing care refers to delays or omissions in providing the right treatment, which can be influenced by staffing levels, work environment, and teamwork. Medication errors, including intravenous medication errors, are often underreported due to fears of repercussions and concerns about administrative responses. Patient falls are a significant concern, especially for older individuals with reduced mobility and postoperative patients experiencing confusion. Additionally, nurses are at high risk of developing musculoskeletal disorders from manually lifting patients, leading to potential injuries and long-term effects. Furthermore, workplace violence and bullying can impact nurses' ability to provide safe patient care. To enhance patient safety, nurses must foster open communication, collaborate with healthcare teams, and implement injury prevention programs.
| Characteristics | Values |
|---|---|
| Medication errors | Giving the wrong medication, incorrect dose, or omitting a prescribed medication |
| Equipment errors | Failing to operate machinery properly or causing injury when setting up or removing equipment |
| Monitoring errors | Failing to recognize signs of deterioration or alert a physician promptly |
| Miscommunication | Misunderstandings about medication schedules, physician orders, and patient records |
| Documentation errors | Inadequate or incorrect record-keeping |
| Failure to meet standards of care | Failing to meet the minimum standard of care expected of a nurse |
| Negligence | Failing to act within the scope of practice as another reasonable practitioner would |
| Workplace injuries | Overexertion, slips, trips, falls, needle sticks, patient handling, and workplace violence |
| Musculoskeletal injuries | Sprains, strains, slipped discs, and repetitive stress injuries |
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What You'll Learn
- Medication errors: wrong medication, incorrect dose, or omission of prescribed medication
- Equipment misuse: failing to operate machinery properly or injuring a patient during setup or removal
- Poor patient monitoring: not recognising deterioration or failing to promptly alert a physician
- Miscommunication: misunderstandings about medication schedules, physician orders, and patient records
- Inadequate record-keeping: incorrect or inadequate documentation that complicates investigations
Medication errors: wrong medication, incorrect dose, or omission of prescribed medication
Medication errors are the most common cause of patient injury and can occur when a nurse administers the wrong medication, provides an incorrect dose, or omits a prescribed medication. Nurses must be educated and up to date on various medications, their safe delivery, and the physiological factors influencing drug absorption rates and time of drug onset. For example, the bioavailability of a drug depends on its method of administration, with intravenously administered drugs having a higher bioavailability and faster onset of action. Nurses must also be aware of the patient's age and weight to ensure the correct dosage is administered. For instance, the placement of a decimal point in a prescription can impact the dose of medication by up to tenfold, and micrograms and milligrams can be mistaken with a quick glance.
To avoid medication errors, nurses should consult with pharmacy personnel, use calculators for arithmetic, and cross-consult with patients or their families about usual doses. Barcode medication administration (BCMA) is a modern technology that allows nurses to verify the five rights of medication administration by electronically scanning a patient's wristband and cross-matching it with their medical chart. This has been shown to decrease medication administration errors by up to 56%. Additionally, implementing a "do not interrupt" intervention for nurses during medication administration can help minimize interruptions and reduce non-medication-related interruptions.
Incorrect dosing can include overdose, underdose, omission of a scheduled dose, or an extra dose. It can also occur due to incorrect routes, which often result in significant morbidity and mortality. Incorrect dosage forms are also considered medication errors, such as when a patient receives immediate-release medication instead of extended-release. Dispensing a drug that a patient is allergic to is often due to poor communication, inappropriate chart review, inaccurate charting, or a lack of a technological interface.
If a patient is injured due to a nurse's medication error, they may be able to sue the hospital employing the nurse or the supervising doctor. To receive compensation, the patient must prove that the nurse's mistake directly caused or significantly contributed to their injury and that they suffered harm as a result. Hospitals can be held liable for a nurse's negligence if the nurse is employed by the hospital and acting within the scope of their job duties.
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Equipment misuse: failing to operate machinery properly or injuring a patient during setup or removal
Nurses often face workplace hazards while performing routine duties, and they have a higher-than-average risk of sustaining musculoskeletal injuries. Needle sticks, patient handling, overexertion and bodily reaction, slips, trips, and falls, and workplace violence are some of the most common causes of injuries in nurses.
Equipment misuse by nurses can also lead to patient injuries. For example, a nurse may fail to operate medical machinery properly or cause injury to a patient while setting up or removing equipment. This can include failing to follow proper procedures when using medical devices, which can lead to accidents and injuries. Inadequate understanding of safety protocols and improper training can contribute to these types of incidents.
In the United States, hospitals are generally responsible for a nurse's negligence under the doctrine of vicarious liability if the nurse is employed by the hospital and acting within the scope of their job duties. If a nurse's actions fall below the standard of care and directly cause or contribute to a patient's injury, they or the hospital may be sued for malpractice or negligence.
To prove malpractice or negligence, it must be shown that the nurse's mistake directly caused or significantly contributed to the patient's injury. A medical expert typically testifies about how the nurse's actions or inactions led to harm or worsened the patient's condition. If the patient's decline was unrelated to the nurse's error, compensation is typically not available.
It is important to note that equipment misuse accidents can be prevented through proper training, adherence to safety guidelines, and regular maintenance of machinery.
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Poor patient monitoring: not recognising deterioration or failing to promptly alert a physician
Poor patient monitoring by nurses can have severe consequences for patients and may constitute malpractice if it leads to patient injury. Monitoring patients is a critical part of a nurse's role, and failing to recognise signs of deterioration or to alert a physician promptly can be considered negligence. For example, if a nurse fails to monitor a pregnant woman's health properly, they could miss signs of placental abruption or preeclampsia, which could result in death or serious injury to the mother or baby.
Vital signs monitoring plays a significant role in detecting acute deterioration, which may occur at any time during a patient's admission. If monitoring is intermittent or infrequent, or does not include the right parameters, acute deterioration may go undetected, delaying appropriate treatment and resulting in serious adverse outcomes. For instance, in the case of a patient under anaesthesia, failure to monitor vital signs can lead to tragic outcomes.
To ensure effective patient monitoring, it is necessary to develop systems that consistently measure vital signs and other parameters for detecting deterioration in a patient's physical, mental, or cognitive condition. These systems should ensure that the right parameters are monitored for each patient, at the appropriate frequency and duration. For example, in the ICU, cardiac resuscitation, and surgical settings, continuous capnography is recommended for identifying respiratory deterioration.
However, it is important to note that no single parameter will identify early deterioration in all patients. Instead, combinations of variables need to be monitored, and the information integrated to gain a full picture of the patient's condition. Vigilance, or staying alert to potential dangers, is also crucial in patient monitoring. Alarm fatigue, caused by frequent false alarms, can compromise patient safety as nursing staff may become desensitised and fail to react or adjust settings.
When a patient is injured due to a nurse's careless actions or negligence, they may have legal recourse. A patient can file a lawsuit, proving that the nurse's mistake directly caused or contributed to their injury and that they suffered harm as a result. In such cases, the hospital employing the nurse may also be held liable under the doctrine of vicarious liability.
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Miscommunication: misunderstandings about medication schedules, physician orders, and patient records
Effective communication between doctors and nurses is essential to providing high-quality patient care. When communication breaks down, care standards fall, and patients can suffer. Miscommunication between nurses, doctors, and other healthcare providers can lead to misunderstandings about medication schedules, physician orders, and patient records, which can have serious consequences for patients.
Misunderstandings about medication schedules can arise from a variety of factors. For example, similarly named medications may have drastically different mechanisms of action or indications for prescribing. Poor handwriting and abbreviations can also lead to errors, as can a misplaced decimal point or confusion over unit abbreviations. Nurses must also be educated and up to date on newer medications or less commonly administered drugs, as well as having a basic understanding of the physiology influencing drug absorption rates and onset times.
To avoid misunderstandings about physician orders, it is important for nurses and doctors to have a clear understanding of each other's roles and responsibilities. Structured communication tools such as SBAR (situation, background, assessment, recommendation) can help to ensure information is communicated clearly and concisely, both verbally and in writing.
Inaccurate or incomplete patient records can also contribute to adverse outcomes and complicate investigations. It is important for nurses to keep detailed, accurate records of patient care, including medication administration, to ensure continuity of care and patient safety.
Ultimately, when there is a breakdown in communication between nurses and doctors, it is the patient that suffers. This can result in longer hospital stays, slower recovery times, and in some cases, more serious consequences. It is therefore essential for healthcare providers to implement strategies to improve communication and collaboration, such as team training and the use of health IT solutions.
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Inadequate record-keeping: incorrect or inadequate documentation that complicates investigations
In nursing, record-keeping is an essential aspect of patient care and safety. Accurate and complete documentation provides a trace of the care processes that have been performed and supports clinical decision-making. It also serves as a communication tool among nurses for continued patient management. However, inadequate record-keeping can have significant adverse effects, complicating investigations and contributing to negative patient outcomes.
Nurses are responsible for ensuring that patient records are accurate and up-to-date. Inaccurate or incomplete documentation can lead to misunderstandings about medication schedules, physician orders, and patient care. This can ultimately result in medication errors, such as administering the wrong medication or an incorrect dose, which can have severe consequences for patients.
Poor record-keeping also makes it challenging to prove that care was provided, as the saying goes, "what is not recorded has not been done." In the event of a malpractice lawsuit or licensing board disciplinary action, incomplete or missing records can hinder the defence of a nurse's actions. Furthermore, incorrect or fraudulent documentation can lead to complaints and legal claims, as it may indicate a breakdown in communication or improper nursing processes.
Several factors contribute to inadequate record-keeping among nurses. Work overload, increased patient movement, and inadequate recording materials or staffing resources are common challenges that nurses face. These obstacles can lead to incomplete or untimely documentation, affecting data accuracy and patient care. Additionally, poor handwriting and errors in electronic health records (EHR) further contribute to documentation errors.
To improve record-keeping practices, it is essential to address the underlying issues. Increasing the number of nurses in healthcare facilities can help reduce the workload and provide more time for accurate documentation. Additionally, implementing clear and concise documentation protocols, improving communication strategies, and utilising user-friendly recording systems can enhance the quality and completeness of patient records.
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Frequently asked questions
Patient injuries can occur due to environmental conditions, physiological factors, or cognitive/psychological factors. Some common causes of patient injury include medication errors, infections, falls, pressure injuries, and adverse events during treatment.
Nurses may contribute to patient injuries through missed nursing care, which can be caused by factors such as inadequate staffing levels, a poor work environment, or lack of teamwork. Additionally, nurses may fail to detect clinical deterioration, understand care processes, or communicate changes in a patient's condition effectively.
Patient injuries can have significant consequences, including increased morbidity and mortality rates, prolonged hospital stays, and financial burdens on the healthcare system. Patient injuries may also lead to legal and ethical implications for nurses and healthcare institutions.
To prevent patient injuries, nurses should assess each patient's safety factors, including age, developmental stage, health status, and cognitive awareness. Additionally, implementing safety protocols, such as the "five rights" of medication administration, using assistive equipment, and fostering open communication within the healthcare team, can help reduce the risk of patient injuries.
