Common Breaches of the Standard of Care

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

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