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A 55-year old female was transported to the floor after recovering from a surgical procedure. An epidural catheter with morphine was placed for post-operative pain control. Upon arrival, the patient complained of nausea and a headache prompting the on-call physician to prescribe, “Demerol 75mg every three hours for pain.”

The preprinted medication orders from anesthesia stated “No narcotics, sedatives, or other respiratory depressants to be given during infusion of epidural medication and for 12 hours after epidural is discontinued except by order of anesthesia.”

The nurse had not reviewed this order prior to obtaining and administering the new order for Demerol, a narcotic.

Twenty minutes later, the patient was found unresponsive and aggressive resuscitation efforts were implemented, resulting in intubation and mechanical ventilation of the patient. When brain activity was not found, the family made the decision to take the patient off of life support and the patient died shortly thereafter.

The patient’s family filed a lawsuit claiming negligence in administering the medication. A verdict was entered against the nurse for nearly $4 million

- Which role of the professional nurse did this nurse fail to fulfill? (select All that apply)

- Communication
- Coordinator of care
- Patient advocate
- Patient educator

- Which legal tort was the nurse guilty of regarding care of this patient?

- Assault
- Battery
- Intentional
- Negligence

- What standard(s) of nursing practice did the nurse fail to implement? (select All that apply)

- Administer Narcan to the patient in respiratory distress
- Clarify the order with the physician
- Know the contraindications for the medication being administered
- Recognize incomplete order

- What actions could the nurse have taken to change the outcome of this case? (select All that apply)

- Completed the 6 rights of medication administration but not question the physician
- Follow up to check on patient in a timely manner
- Place patient on continuous pulse oximetry and vital signs monitoring
- Reassess the patient after giving the medication
- Review all orders prior to administering medication.

- What are the possible criminal legal ramifications for this nurse? (select All that apply)

- Sentenced to time in jail if convicted of a crime
- Unwanted publicity
- Additional education required by the board of nursing
- Probation of nurse licensure by the board of nursing
- Revocation of nurse licensure by the board of nursing

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