Common breaches of the standard of care include but are not limited to:
Correctional Nursing
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Failure to refer to a physician or consultant in a timely and proper manner
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Failure to detect and report signs and symptoms of a medical condition
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Failure to maintain the secure maintenance of needles, blades, and sharps
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Failure to properly track disposal and destruction of hazardous waste
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Failure to be fully aware of safety and security procedures that address contraband, metal detectors, proper identification, and response to security breaches
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Failure to properly triage
Office Nursing
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Failure to make a proper nursing diagnosis or use good nursing judgment when a patient calls with signs and symptoms that are indicative of a medical problem
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Failure to properly administer medication (e.g., intramuscular injection causing sciatic nerve injury)
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Failure to administer medication
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Failure to notify the patient of important test results (e.g., Pap smear, mammogram screenings showing a malignancy) in a timely and proper manner
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Failure to refer or recommend to physician a referral to a specialist or for additional testing (e.g., ultrasound of a suspicious mammogram finding)
Case Manager
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Failure to exercise due care in the discharge of contractual duties
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Failure to properly document care activities
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Failure to properly document outcomes
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Failure to inform a subscriber of a managed-care company of the contractual right to an impartial review of a disputed claim
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Failure to inform a subscriber of a managed-care company of the contractual right to an arbitration
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Failure to obtain all the necessary documents and medical records, resulting in the denial of care
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Failure to properly investigate the qualifications and competencies of the providers and facilities to which patients
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Failure to act as patients’ advocates
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Unethical behavior in the form of “kickbacks”
Occupational Nursing
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Failure to detect signs and symptoms of a condition
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Failure to properly document all treatment and medications given to employees
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Failure to refer to a physician or consultant
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Failure to timely and properly treat
Emergency Care
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Failure to properly monitor the patient
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Failure to provide a safe environment (e.g., patient falls from stretchers)
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Failure to give proper discharge instructions, referrals and/or medications
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Failure to timely and/or properly administer medication
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Failure to timely and properly triage
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Failure to take an accurate and thorough history
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Failure to assess the patient in a timely and proper manner
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Failure to give proper telephone advice and/or triage
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Failure to properly report signs and symptoms of the patient to the physician on call
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Failure to properly gather evidence and preserve the chain of custody
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Failure to perform cardiopulmonary resuscitation (CPR) in a timely and proper manner
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Failure to honor advance directives
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Failure to report suspected patient, spousal, child, or elder abuse
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Failure to discharge patient to the proper facility or via the appropriate means, such as ambulance or relative
Pediatrics/Neonatal Intensive Care Unit/Pediatric Intensive Care Unit Nursing
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Failure to properly monitor
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Failure to properly check IV sites which can result in infiltration or infection
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Failure to prevent falls or injuries from cribs or beds
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Failure to protect the infant from burns (e.g., by a bottle heated in a microwave)
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Failure to prevent or detect over hydration or under hydration
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Failure to report suspected child abuse
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Equipment injuries (e.g., failure to check warmer temperatures)
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Failure to maintain equipment in proper working order (e.g., turning off alarms).
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Failure to properly administer injections
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Failure to properly insert tubes or catheters which can cause tissue and organ damage
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Failure to routinely check IV boards and dressings which can result in infiltration, nerve damage and tissue necrosis
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Failure to properly feed the infant which can result in aspiration
Long-Term Care
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Failure to protect the patient from falls
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Failure to prevent the development of decubitus ulcers
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Failure to detect decubitus ulcers and treat them in a timely manner, resulting in amputations, gangrene, sepsis, or death
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Failure to monitor polypharmacy effects, side effects/adverse reactions, and toxic levels of drugs used by patients
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Failure to provide a safe environment (e.g., prevent wandering off the premises)
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Failure to prevent abuse, neglect, or injury by other patients or the staff
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Failure to prevent burns
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Failure to honor living wills and advance directives
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Failure to properly monitor
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Failure to timely and properly ambulate and prevent emboli
Intravenous Lines
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Failure to properly start an IV resulting in injury to the patient
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Failure to change IV dressings in a proper and timely manner resulting in undetected infection or infiltration
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Failure to properly administer bolus medications or medications via a heparin lock or IV tubing too rapidly resulting in damage to vessels and limbs or death
Orthopedic Nursing
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Failure to properly assess
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Failure to detect signs and symptoms of compartment syndrome
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Failure to detect problems or go through the chain of command to get help for extremities in casts that are constricted
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Failure to detect signs and symptoms of a fat embolism
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Failure to prevent clots
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Failure to prevent decubitus ulcers
General Breaches
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Failure to access care through the hierarchy or chain of command
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Failure to clarify orders
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Failure to provide a safe environment for the patient
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Medication errors
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Failure to follow standards of care or facility policy and procedure
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Failure to recognize or notify the physician of significant changes in the patient’s condition
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Failure to document in a timely and proper manner
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Failure to monitor properly
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Failure to give discharge instructions properly to the patient or family
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Failure to protect patient against harm
Common Medication Errors
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Wrong medication given to patient
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Wrong route of administration
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Wrong site of administration
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Wrong dosage
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Wrong time
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Failure to document administration of drug or failure to timely document
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Transcription errors on the Medication Administration Record (MAR)
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Omission of a dose
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Duplication of a dose
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Administration of a drug not ordered
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Administration of a drug to a patient who has a known allergy to the drug as documented in the record
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Failure to detect and obtain timely treatment of an anaphylactic or severe allergic reaction
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Failure to detect signs and symptoms of adverse reactions or drug toxicity
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Failure to properly administer chemotherapy by administering medication outside the therapeutic range
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Failure to select and administer the proper medications when two bottles of different medications look alike (e.g., potassium chloride and sodium chloride)
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Failure to clarify the physician’s order
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Failure to question physician’s order
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Failure to properly administer medication via IV or heparin lock
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Failure to properly administer an injection
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Failure to properly administer medication by giving the medication too quickly