Nursing Malpractice

Nursing malpractice can impact all areas of patient care, whether the patient is undergoing surgery, recovering from an injury in the hospital, or residing in a skilled nursing facility.

Diagnostic Errors

Diagnostic errors occur when advanced nurses, such as nurse practitioners, misdiagnose a condition, fail to diagnose a condition, or delay a diagnosis. According to a study published by the Journal of Professional Nursing, the highest proportion of medical malpractice cases against nurse practitioners involved diagnostic errors, accounting for 41.46 percent of the malpractice claims brought against nurse practitioners.

All nursing staff has the potential to contribute to diagnostic errors. For example, a nurse who fails to notice or document changes in a patient’s condition may prevent a patient from receiving a timely diagnosis.

Diagnostic errors can lead to the following:

• Untreated pain
• Worsening of a condition
• Operable cancer becoming terminal
• Unnecessary medication
• Extended suffering
• Sudden death

Medication Errors

Medication errors cause more deaths than car accidents, breast cancer, and AIDS combined. They are the most common medical error in hospitals and the eighth leading cause of death in the United States.

Most medication errors occur during the administration of medications, which is primarily performed by nurses. A study by BMC Nursing found that the most common medication errors committed by nurses include the following:

• Administration at the incorrect times
• Failure to document the dispensing of medications
• Incorrect dose
• Incorrect route of administration
• Wrong medication
• Medication provided to the wrong patient

Registered nurses and licensed practical nurses administer medications. RNs have more training and are generally responsible for supervising direct care, including the administration of medications.

Certified nursing assistants are not qualified to administer medications. Illinois law does, however, allow medication aides to administer some medications under the supervision of RNs in long-term care facilities, such as nursing homes.

Negligent Infection Control

Patients who are in the hospital or skilled nursing facilities are often vulnerable to infections due to reduced immune function stemming from age, health conditions, or the stress of recovering from injuries. Other patients present with communicable illnesses or infections that could easily spread to vulnerable patients if strict infection control protocols are not observed.

An effective infection control program with staff compliance can prevent infections from spreading. Unfortunately, infection control procedures such as the following are regularly violated in hospitals and skilled nursing facilities.

• Properly wash hands between patients
• Wear personal protective equipment, such as disposable gloves, gowns, and face masks as required
• Replace or sterilize personal protective equipment between patients
• Effectively isolate contagious patients
• Use gloves or appropriately wash hands before applying medical equipment to patients
• Use appropriate sterilization techniques for equipment

Patients that require care for open wounds, catheterization, kidney dialysis, and other invasive procedures require a sterile environment. These patients are vulnerable to airborne infections and contaminated equipment.

Staph infections in hospitals and nursing homes, including methicillin-resistant Staphylococcus aureus (MRSA), are rampant. These dangerous infections can lead to sepsis and death.

Negligent Infection Control in Nursing Homes

The U.S. Government Accountability Office found that 82 percent of nursing homes nationwide had been cited for infection control deficiencies, and approximately half of these violations occurred repeatedly over multiple years.

A report by the Chicago Tribune stated that Illinois nursing homes rank as the third worst in the nation, with 89 percent cited for infection control violations since 2016.

The Friends Services Alliance, a senior services organization, has found that the following infection control deficiencies are among the most common in nursing homes:

• Improper use of personal protective equipment
• Improper handling and storage of equipment and supplies
• Improper handling of soiled linens
• Unsafe food handling practices
• Inadequate hand hygiene

Failure to Prevent Falls

Patient falls are the most common adverse event in hospitals, according to Clinical Geriatric Medicine, with up to one million hospital falls in the United States annually. Falling in the hospital can cause significant physical injuries and death, especially in older adults.

Acute care patients may be more likely than usual to fall due to injuries and medications that affect balance, orientation, and strength. Elderly patients may have health conditions and disabilities that increase their fall risks.

In either case, nursing staff is responsible for supervising patients, providing assistance with ambulation, and taking steps to mitigate fall risks, including the following:

• Assist patients with daily activities, including showering and toileting
• Adjust bed rails as necessary to prevent falling out of bed
• Closely supervise at-risk patients during ambulation
• Document and report symptoms such as dizziness that could impair balance

Equipment Injuries

Nursing in today’s medical environment requires familiarity with medical equipment used for therapeutic, diagnostic, and monitoring purposes, including high-tech equipment. As frontline staff, nurses are the staff most likely to be present when equipment malfunctions. Nurses often handle equipment such as the following:

• Electronic IV pumps
• Digital monitors
• Wearable monitoring devices
• Oxygen delivery systems
• Catheters
• Feeding tubes
• Electronic medical records
• Smart beds

Operating equipment incorrectly or failing to ensure patient tubing is applied properly can prevent patients from receiving necessary medications and oxygen. A malfunctioning monitor may fail to provide important health information needed to keep a patient alive.

Nurses have a duty to be highly familiar with medical equipment, including how to identify malfunctions and troubleshoot.

Failure to Prevent Bedsores

Patients who are required to remain in bed for long periods or who are confined to wheelchairs must change positions frequently in order to avoid developing bedsores. It is also crucial for their skin to be kept clean and dry, especially in the areas with the most contact with beds and wheelchairs.

Bedsores, also known as pressure ulcers, are painful and can become life-threatening. Healing from bedsores may take years, and in some cases, healing never occurs.

Pressure ulcers are the most preventable injury a patient can experience, and the occurrence or worsening of a bedsore can almost always be traced to nursing negligence. Pressure ulcers are especially common in nursing homes.

Negligent Communication

Nurses must communicate with patients, doctors, and other care providers. When a patient expresses concerns about pain or new symptoms, nurses should gather as much information as possible from the patient and document the conversation. If a nurse suspects the new symptoms require urgent intervention, they should notify the physician.

Nursing Home Abuse and Neglect

Nursing home abuse is a heart-wrenching circumstance endured by millions of vulnerable adults every year. The majority of nursing home abuse is perpetrated by nursing staff and includes the following:

• Physical abuse
• Emotional abuse
• Failure to provide basic needs
• Sexual abuse
• Financial exploitation

Abused and neglected nursing home residents experience bruises, broken bones, malnutrition, and frequent falls. Older adults who experience abuse are twice as likely to die prematurely than adults who are not abused.