Case Study #2: Alleged improper admission orders resulting in
morphine overdose and death
There were multiple co-defendants in
this claim who are not discussed in this scenario. Monetary amounts represent
only the payments made on behalf of the nurse practitioner. Any amounts paid on
behalf of the co-defendants are not available. While there may have been
errors/negligent acts on the part of other defendants, the case, comments, and
recommendations are limited to the actions of the defendant; the nurse
practitioner.
The decedent patient (plaintiff) was
a 72 year old woman who had been receiving hospital care for acute back pain
resulting from a fall. Her past history included chronic pain management and
end-stage renal disease for which she received hemodialysis. She was to be
transferred to the co-defendant nursing facility for reconditioning and
physical therapy prior to returning to her home.
The nurse practitioner (defendant)
was on-call at the time of the patients transfer, and the nursing facility
contacted her and read the orders to the defendant nurse practitioner over the
telephone. The defendant nurse practitioner questioned the presence of two
morphine orders for different dosages with both dosages administered twice
daily. She instructed the nurse to clarify the correct morphine dosage with the
transferring hospitals pharmacist and to admit the patient only after the
pharmacist clarified and approved the morphine orders. The defendant nurse
practitioner had no further communication with the facility and no other
involvement in the patients care. The facility nurse telephoned the hospital
pharmacist who approved both morphine orders, and the patient was admitted to
the nursing facility.
During the first evening and full
day of her nursing facility stay, documentation revealed the patient to be
alert and oriented. On the second day, she was found by nursing staff without
vital signs. Despite immediate chest compressions and EMS additional
resuscitation measures, the patient was pronounced dead. The autopsy results
listed the cause of death as morphine intoxication. Surprisingly, the patient
also had an elevated blood alcohol level (equal to drinking three to four
alcoholic beverages). Because the source of the alcohol could not be identified,
the medical examiner was unable to rule out accident, suicide or homicide and
classified the manner of death as undetermined.
Resolution
Defense experts found the nurse
practitioners actions to be within the standard of care.
Defense experts stated that the
patients final morphine blood levels, even considering her renal disease,
could not have resulted from the amount of morphine ordered, administered and
recorded in the patients health information record. The elevated morphine and
alcohol levels led experts to the opinion that the patient may have ingested
morphine and alcohol from a source other than the nursing facility.
A motion for partial summary
judgment for the defendant nurse practitioner was denied by the court and the
decision was made to proceed to trial. After the completion of testimony but
prior to receiving the verdict the co-defendants settled the case out of court with
no liability attributed to the defendant nurse practitioner.
Discussion
1.
Summarize the case
and the verdict.
2.
Based on your review,
do you agree with the courts decision? Defend/discuss your answer.
3.
What practice-related
legal 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 type
of issue(s) from reoccurring.
Case Study #2: Alleged improper admission orders resulting in
morphine overdose and deathThere were multiple co-defendants in
this claim who are not discussed in this scenario. Monetary amounts represent
only the payments made on behalf of the nurse practitioner. Any amounts paid on
behalf of the co-defendants are not available. While there may have been
errors/negligent acts on the part of other defendants, the case, comments, and
recommendations are limited to the actions of the defendant; the nurse
practitioner.The decedent patient (plaintiff) was
a 72 year old woman who had been receiving hospital care for acute back pain
resulting from a fall. Her past history included chronic pain management and
end-stage renal disease for which she received hemodialysis. She was to be
transferred to the co-defendant nursing facility for reconditioning and
physical therapy prior to returning to her home. The nurse practitioner (defendant)
was on-call at the time of the patients transfer, and the nursing facility
contacted her and read the orders to the defendant nurse practitioner over the
telephone. The defendant nurse practitioner questioned the presence of two
morphine orders for different dosages with both dosages administered twice
daily. She instructed the nurse to clarify the correct morphine dosage with the
transferring hospitals pharmacist and to admit the patient only after the
pharmacist clarified and approved the morphine orders. The defendant nurse
practitioner had no further communication with the facility and no other
involvement in the patients care. The facility nurse telephoned the hospital
pharmacist who approved both morphine orders, and the patient was admitted to
the nursing facility.During the first evening and full
day of her nursing facility stay, documentation revealed the patient to be
alert and oriented. On the second day, she was found by nursing staff without
vital signs. Despite immediate chest compressions and EMS additional
resuscitation measures, the patient was pronounced dead. The autopsy results
listed the cause of death as morphine intoxication. Surprisingly, the patient
also had an elevated blood alcohol level (equal to drinking three to four
alcoholic beverages). Because the source of the alcohol could not be identified,
the medical examiner was unable to rule out accident, suicide or homicide and
classified the manner of death as undetermined.ResolutionDefense experts found the nurse
practitioners actions to be within the standard of care. Defense experts stated that the
patients final morphine blood levels, even considering her renal disease,
could not have resulted from the amount of morphine ordered, administered and
recorded in the patients health information record. The elevated morphine and
alcohol levels led experts to the opinion that the patient may have ingested
morphine and alcohol from a source other than the nursing facility. A motion for partial summary
judgment for the defendant nurse practitioner was denied by the court and the
decision was made to proceed to trial. After the completion of testimony but
prior to receiving the verdict the co-defendants settled the case out of court with
no liability attributed to the defendant nurse practitioner. Discussion1.
Summarize the case
and the verdict.2.
Based on your review,
do you agree with the courts decision? Defend/discuss your answer.3.
What practice-related
legal 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 type
of issue(s) from reoccurring.
