Nursing Mistakes in a Hospital Setting

Nursing Mistakes NegligenceEvery year in Florida patients in a hospital setting are hurt through nursing mistakes. Nursing malpractice can happen to you in a hospital’s many departments: in the intensive care unit, in an operating room, during a routine radiology procedure, or on the hospital’s floor unit where you may be recovering from surgery or an illness.

What is Considered Negligence in Nursing?

Under the law, negligence is defined as the failure to use such care as a reasonable person would use under similar circumstances. In nursing this means the nurse failed to act according to what is known as the “standard of care.” The actual standard of nursing care is usually proven through the opinion of another nurse in the same field; oftentimes this nurse is considered an “expert witness.” This nurse would testify that the actions taken by the nurse in question did or did not meet the required minimum level of care within the nurse’s specialty. This level is determined by looking at the medical provider’s own policies and procedures as well as an evaluation of local and national standards.

Elements of Negligence in Nursing

Although not all cases are the same, four basic elements need to be proven in all negligence claims. The general rule is that if all four elements of a claim are not proven by the greater weight of the evidence, then the entire claim will fail.

The four elements that a plaintiff, through his or her attorney, must prove to win a negligence suit are:

  • duty
  • breach
  • causation
  • losses

Nurses are under a “duty of care,” which is often interchangeable with the standard of care discussed above. The duty of care is a requirement that a nurse care for his or her patients with the same watchfulness, attention, caution, and prudence as a reasonable person would utilize in the same situation. Failure to meet this standard constitutes a “breach” of the duty of care. Once duty and breach have been proven, the nurse’s actions are considered negligent. To recover for losses as a result of this negligence, it must be proven that those losses were actually caused by the nurse’s negligence. Once all of these requirements have been met, the extent of losses caused by the nurse’s negligence is calculated. Those recoverable losses include medical bills, pain, suffering, the loss of enjoyment of life, inconvenience, the cost of future medical care, and other related losses.

The injured party has the responsibility of proving the nurse failed to meet the required minimum standard of care. It is the responsibility of the injured party’s attorney to prove all four elements of the negligence claim by “the greater weight of the evidence.” This simply means that there is more evidence showing that each of the elements has been proven than there is evidence to the contrary.

Types of Nursing Mistakes in a Hospital Setting

You may suffer as a result of a nurse’s failure to document and communicate to your physician any change in your vital signs or neurologic status. A nurse may neglect to reposition you to avoid painful and potentially dangerous bedsores. Medication administration errors by nurses in hospitals are also more frequent than anyone would like to admit. Another mistake is the failure to timely monitor and to assess you while you are under a nurse’s care.

Failure to Document and Communicate to the Physician a Change in Vital Signs

The failure to properly document and communicate a change or changes in your vital signs can be a life and death matter. Cases of nursing malpractice may begin with chart review to determine what acts or omissions were made that deviated from the nursing standard of care as established by policies and procedures in the form of manuals, textbooks, and generally recognized methods of practice.

A shift in your heart rate, temperature, blood pressure, oxygen saturation level, respiration, urine output, or pain level could be critical. If a nurse makes a mistake in recording the correct information, there could be dire consequences. If a hospital nurse administers a drug to you but doesn’t document it on your chart, a colleague could administer the same drug at a later point, leading to a medication overdose.

The transfer of essential information and the responsibility for your care from one health care provider to another—as in a routine shift change—is an integral part of communication. This critical transfer point is known as a handoff. An effective handoff supports the transition of critical information and continuity of care and treatment. An ineffective or faulty handoff of your vital sign information may have an adverse effect and present safety risks. It’s also been proven that manual documentation errors on charts are far greater than when a nurse can record vital signs directly through electronic means.

In summary, without accurate recording of vitals in the chart, it is difficult to confirm a nurse or doctor’s actions and findings about you as a patient. Without accurate vital signs, it isn’t possible to ask pertinent questions, order proper tests, and prescribe optimal treatment.

Nursing Failure to Communicate a Change in Neurologic Status

An initial neurological evaluation is usually a comprehensive examination covering several critical areas of assessment, including level of consciousness (LOC), orientation, speech, facial symmetry, motor and sensory function and reflex activity. Assessment of your cranial nerve function, cerebellar function, and reflex activity are also elements of a comprehensive neurological assessment.

Evaluation of LOC, using the Glasgow Coma Scale (GCS), is based on three responses: eye opening, motor, and verbal response. The total score ranges from 3 (coma) to 15 (fully conscious, alert, and oriented). In addition to performing the GCS, assessment of your pupil size, shape, and equality before and after exposure to light is an integral part of a neurological exam.

A change in your pupillary response, such as unequal or dilated pupils, can be a warning sign of increasing intracranial pressure (ICP) from swelling, bleeding, or some other cause. A nurse’s failure to properly conduct such an assessment, especially if you are a head injury or stroke patient, could prove catastrophic.

Nursing Failure to Reposition a Patient to Avoid Bedsores

If you are confined to a hospital bed because of illness or an injury or are under anesthesia for an operation, your movement is minimal if any. As a result, pressure builds up on specific areas of the body where the bones are prominent— the lower part of your back near the buttocks and your heels if you’re lying on your back or, if you’re on your side, your hip and ankle. When you do move, or are moved incorrectly, friction may add to the problem of pressure.

In just a couple of hours, that pressure can squeeze shut the capillaries that deliver blood to the skin and underlying tissue. Without fresh blood to bring in oxygen and flush out metabolic waste, skin and other nearby tissues suffer and may eventually die. In common speech, a bedsore has begun, also known as pressure or decubitus ulcers.

Bedsores are reported as the underlying cause of death of a couple of thousand Americans each year. Some experts say that the official tally underestimates the mortality risk because bedsores can lead to blood infections (septicemia) and other fatal conditions.

A nursing failure to reposition you to avoid bedsores or pressure ulcers can inhibit your recovery, resulting in a prolonged hospital stay. They can be painful and may create an opportunity for infections to spread to the surrounding skin, deeper tissue, bone, and the blood. The breakdown of tissue from large bedsores can lead to fluid and protein loss, leaving patients dehydrated and malnourished.

Medication Administration Errors

Nursing medication errors—wrong patient, wrong dose, wrong drug, wrong route—are a leading cause of death in a hospital setting in this country. Failure to treat patients effectively for an underlying disease or condition with the proper and correct medication can exacerbate illness or injury, causing a missed opportunity for them to recover normal or optimal function.

Failure to Timely Monitor and Assess a Patient

The primary duty of your hospital’s nurses is patient safety. They are your advocates, assessing you, forming a diagnosis, and making recommendations to medical staff for orders. Timely monitoring and assessing you requires regular surveillance to track any changes in your condition and recognizing any deterioration in your condition. Missed nursing care is an error of omission. It refers to nursing care you need that is delayed, partially completed, or not completed at all, such as monitoring vital signs in a timely manner, consulting your chart and accurately recording your condition.

The more routine consequences of missed nursing care can include delayed or omitted medications or treatments ordered by your physician. It can also mean complications, falls, infections, and increased length of hospital stay. If your nurse fails to respond to your call light, for example, and you are experiencing debilitating pain or inability to reach the restroom, it can be a threat to your health. If missed hospital nursing care becomes routine through time and resource pressure, you are the one who suffers.

Compensation If You Are a Victim of a Nursing Mistake in a Hospital Setting

If you or a loved one has been hurt as a result of a nursing mistake in a hospital setting, Jim Dodson Law is here to answer your questions and advise you on the right course of action. We have extensive experience in this area of helping clients to obtain the financial compensation they deserve for their pain, suffering, lost wages, and loss of enjoyment of life.

Jim Dodson
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A Florida injury lawyer, family man and avid cyclist who clients have trusted for over 25 years.