Defense experts found the nurse practitioner’s actions to be within the standard of care.
Defense experts found the nurse practitioner’s actions to be within the standard of care.
Case Study #2: Alleged improper admission orders resulting inmorphine overdose and death
There were multiple co-defendants inthis claim who are not discussed in this scenario. Monetary amounts representonly the payments made on behalf of the nurse practitioner. Any amounts paid onbehalf of the co-defendants are not available. While there may have beenerrors/negligent acts on the part of other defendants, the case, comments, andrecommendations are limited to the actions of the defendant; the nursepractitioner.
The decedent patient (plaintiff) wasa 72 year old woman who had been receiving hospital care for acute back painresulting from a fall. Her past history included chronic pain management andend-stage renal disease for which she received hemodialysis. She was to betransferred to the co-defendant nursing facility for reconditioning andphysical therapy prior to returning to her home.
The nurse practitioner (defendant)was on-call at the time of the patient’s transfer, and the nursing facilitycontacted her and read the orders to the defendant nurse practitioner over thetelephone. The defendant nurse practitioner questioned the presence of twomorphine orders for different dosages with both dosages administered twicedaily. She instructed the nurse to clarify the correct morphine dosage with thetransferring hospital’s pharmacist and to admit the patient only after thepharmacist clarified and approved the morphine orders. The defendant nursepractitioner had no further communication with the facility and no otherinvolvement in the patient’s care. The facility nurse telephoned the hospitalpharmacist who approved both morphine orders, and the patient was admitted tothe nursing facility.
During the first evening and fullday of her nursing facility stay, documentation revealed the patient to bealert and oriented. On the second day, she was found by nursing staff withoutvital signs. Despite immediate chest compressions and EMS additionalresuscitation measures, the patient was pronounced dead. The autopsy resultslisted the cause of death as morphine intoxication. Surprisingly, the patientalso had an elevated blood alcohol level (equal to drinking three to fouralcoholic beverages). Because the source of the alcohol could not be identified,the medical examiner was unable to rule out accident, suicide or homicide andclassified the manner of death as undetermined.
Resolution
Defense experts found the nursepractitioner’s actions to be within the standard of care.
Defense experts stated that thepatient’s final morphine blood levels, even considering her renal disease,could not have resulted from the amount of morphine ordered, administered andrecorded in the patient’s health information record. The elevated morphine andalcohol levels led experts to the opinion that the patient may have ingestedmorphine and alcohol from a source other than the nursing facility.
A motion for partial summaryjudgment for the defendant nurse practitioner was denied by the court and thedecision was made to proceed to trial. After the completion of testimony butprior to receiving the verdict the co-defendants settled the case out of court withno liability attributed to the defendant nurse practitioner.
Discussion
1.Summarize the caseand the verdict.
2.Based on your review,do you agree with the court’s decision? Defend/discuss your answer.
3.What practice-relatedlegal and/or ethical issues were breached and by whom? What other defendants[personnel] may be responsible? How?
4.Identify a risk management action plan to prevent this typeof issue(s) from reoccurring.
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