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

Disclaimer: This website provides only general information about the office of Tonia Aiken, RN, JD and should not be interpreted as legal advice. Any visitation to this site or any inquiries submitted do not represent an attorney-client relationship. Only a contract executed between the individual and Tonia Aiken, RN, JD can form an attorney-client relationship.