Common breaches of the standard of care include but are not limited to:


Correctional Nursing


  • Failure to refer to a physician or consultant in a timely and proper manner

  • Failure to detect and report signs and symptoms of a medical condition

  • Failure to maintain the secure maintenance of needles, blades, and sharps

  • Failure to properly track disposal and destruction of hazardous waste

  • Failure to be fully aware of safety and security procedures that address contraband, metal detectors, proper identification, and response to security breaches

  • Failure to properly triage


Office Nursing


  • 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

  • Failure to properly administer medication (e.g., intramuscular injection causing sciatic nerve injury)

  • Failure to administer medication

  • Failure to notify the patient of important test results (e.g., Pap smear, mammogram screenings showing a malignancy) in a timely and proper manner

  • 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


  • Failure to exercise due care in the discharge of contractual duties

  • Failure to properly document care activities

  • Failure to properly document outcomes

  • Failure to inform a subscriber of a managed-care company of the contractual right to an impartial review of a disputed claim

  • Failure to inform a subscriber of a managed-care company of the contractual right to an arbitration

  • Failure to obtain all the necessary documents and medical records, resulting in the denial of care

  • Failure to properly investigate the qualifications and competencies of the providers and facilities to which patients

  • Failure to act as patients’ advocates

  • Unethical behavior in the form of “kickbacks”


Occupational Nursing


  • Failure to detect signs and symptoms of a condition

  • Failure to properly document all treatment and medications given to employees

  • Failure to refer to a physician or consultant

  • Failure to timely and properly treat


Emergency Care


  • Failure to properly monitor the patient

  • Failure to provide a safe environment (e.g., patient falls from stretchers)

  • Failure to give proper discharge instructions, referrals and/or medications

  • Failure to timely and/or properly administer medication

  • Failure to timely and properly triage

  • Failure to take an accurate and thorough history

  • Failure to assess the patient in a timely and proper manner

  • Failure to give proper telephone advice and/or triage

  • Failure to properly report signs and symptoms of the patient to the physician on call

  • Failure to properly gather evidence and preserve the chain of custody

  • Failure to perform cardiopulmonary resuscitation (CPR) in a timely and proper manner

  • Failure to honor advance directives

  • Failure to report suspected patient, spousal, child, or elder abuse

  • 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


  • Failure to properly monitor

  • Failure to properly check IV sites which can result in infiltration or infection

  • Failure to prevent falls or injuries from cribs or beds

  • Failure to protect the infant from burns (e.g., by a bottle heated in a microwave)

  • Failure to prevent or detect over hydration or under hydration

  • Failure to report suspected child abuse

  • Equipment injuries (e.g., failure to check warmer temperatures)

  • Failure to maintain equipment in proper working order (e.g., turning off alarms).

  • Failure to properly administer injections

  • Failure to properly insert tubes or catheters which can cause tissue and organ damage

  • Failure to routinely check IV boards and dressings which can result in infiltration, nerve damage and tissue necrosis

  • Failure to properly feed the infant which can result in aspiration


Long-Term Care


  • Failure to protect the patient from falls

  • Failure to prevent the development of decubitus ulcers

  • Failure to detect decubitus ulcers and treat them in a timely manner, resulting in amputations, gangrene, sepsis, or death

  • Failure to monitor polypharmacy effects, side effects/adverse reactions, and toxic levels of drugs used by patients

  • Failure to provide a safe environment (e.g., prevent wandering off the premises)

  • Failure to prevent abuse, neglect, or injury by other patients or the staff

  • Failure to prevent burns

  • Failure to honor living wills and advance directives

  • Failure to properly monitor

  • Failure to timely and properly ambulate and prevent emboli


Intravenous Lines


  • Failure to properly start an IV resulting in injury to the patient

  • Failure to change IV dressings in a proper and timely manner resulting in undetected infection or infiltration

  • 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


  • Failure to properly assess

  • Failure to detect signs and symptoms of compartment syndrome

  • Failure to detect problems or go through the chain of command to get help for extremities in casts that are constricted

  • Failure to detect signs and symptoms of a fat embolism

  • Failure to prevent clots

  • Failure to prevent decubitus ulcers


General Breaches


  • Failure to access care through the hierarchy or chain of command

  • Failure to clarify orders

  • Failure to provide a safe environment for the patient

  • Medication errors

  • Failure to follow standards of care or facility policy and procedure

  • Failure to recognize or notify the physician of significant changes in the patient’s condition

  • Failure to document in a timely and proper manner

  • Failure to monitor properly

  • Failure to give discharge instructions properly to the patient or family

  • Failure to protect patient against harm


Common Medication Errors


  • Wrong medication given to patient

  • Wrong route of administration

  • Wrong site of administration

  • Wrong dosage

  • Wrong time

  • Failure to document administration of drug or failure to timely document

  • Transcription errors on the Medication Administration Record (MAR)

  • Omission of a dose

  • Duplication of a dose

  • Administration of a drug not ordered

  • Administration of a drug to a patient who has a known allergy to the drug as documented in the record

  • Failure to detect and obtain timely treatment of an anaphylactic or severe allergic reaction

  • Failure to detect signs and symptoms of adverse reactions or drug toxicity

  • Failure to properly administer chemotherapy by administering medication outside the therapeutic range

  • Failure to select and administer the proper medications when two bottles of different medications look alike (e.g., potassium chloride and sodium chloride)

  • Failure to clarify the physician’s order

  • Failure to question physician’s order

  • Failure to properly administer medication via IV or heparin lock

  • Failure to properly administer an injection

  • Failure to properly administer medication by giving the medication too quickly




© 2013 Tonia D. Aiken, RN, JD

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