Medication errors are a critical concern within the healthcare system, with potential consequences that can be life-altering. When examining medical records in the context of legal cases, legal nurse consultants and legal professionals often start by assessing adherence to the “6 Rights” of medication administration. These rights are the cornerstone of safe medication practices, but it’s essential to recognize that there is more to medication safety than meets the eye.
The 6 rights
The 6 Rights of medication administration include:
Right Patient: Ensuring the medication is intended for the correct individual.
Right Drug: Confirming the medication’s accuracy and appropriateness for the patient’s condition.
Right Dose: Administering the precise amount of medication as prescribed.
Right Route: Delivering the medication through the appropriate route (oral, intravenous, etc.).
Right Time: Administering the medication at the ordered time, considering the medication’s indication.
Right Documentation: Thoroughly recording all administration details for comprehensive patient records.
Examination of potential issues
These principles seem straightforward, but the intricacies of medication administration can leave room for error. To shed light on the complexities involved, consider the following points:
Scope of Practice: Some medications can only be administered in specific healthcare settings by registered nurses (RNs). For example, paralytic medications and other emergency medications require specialized training to administer due to the increased risk associated with them. Deviating from these guidelines may lead to adverse outcomes due to inappropriate monitoring and treatment of complications.
Pharmacy Oversight: Certain medications, such as heparin, require pharmacy oversight for dose adjustments, even in intensive care units (ICUs). Failure to adhere to these guidelines can have dire consequences.
Critical Care Medications: Most titratable medications, those adjusted based on a patient’s condition, are reserved for critical care areas like the emergency room (ER), ICU, operating room (OR), and labor and delivery (L&D).
Insulin Management: The administration of insulin drips necessitates dosage adjustments based on regularly monitored blood sugar levels. This process demands hourly blood sugar checks and adjustment of the insulin rate as often as every hour, requiring two nurses double-checking the dose during the programming of the pump.
Patient Assessment: Some medications have specific parameters based on the patient’s condition, which RNs must be familiar with to ensure safe administration.
Areas of Liability
In real-life healthcare scenarios and case reviews, the following issues have been observed:
Scope of Practice Violations: Medications administered by RNs via routes beyond their scope of practice can lead to catastrophic outcomes when complications arise, and appropriate monitoring and intervention are lacking.
Disregarding Pharmacy Parameters: Failure to follow pharmacy-set parameters for medication administration can result in administering medications when they are contraindicated, leading to rapid deterioration or even life-threatening situations.
Weight-Based Medication Errors: Weight-based medications require precise calculations and programming into infusion pumps based on the patient’s weight in kilograms. Errors in entering the weight can result in overdosing or underdosing, even if the actual medication dose is correct.
What’s striking is that many of these errors often go undocumented in medical records. The only way to identify these issues is for the reviewer to be acutely aware of the intricacies of medication administration. This is where a legal nurse consultant can play a pivotal role in your case.
In conclusion, while the 6 Rights of medication administration serve as a fundamental guide for healthcare professionals, it’s crucial to recognize the intricate details within this guideline. Medication errors can have far-reaching consequences. A thorough assessment of medical records with the expertise of a legal nurse consultant can make a significant difference in identifying and rectifying such errors, ultimately promoting patient safety and ensuring accountability within the healthcare system.
