Nurse Practitioner - Seeing it for yourself
The Facts
In September 1999, a 52-year-old woman with a 15-year history of migraine went to the emergency department for migraine medication. The emergency department staff gave her nubain and 50 mg of Phenergan. Because the doses provided were higher than normal, the potentiating action of these drugs magnified the sedative effects. In the past, the patient had received similar doses of the drugs in the hospital’s emergency department.
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Vesicant extravasation
Drug challenge
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After the medication was administered, the staff told the patient that someone must drive her home. The patient stated that her husband was waiting in the car for her. A nurse asked the patient to bring the husband into the emergency department and also offered to walk the patient to the car, but the patient refused both requests. The hospital record stated in five places that the husband was driving the patient home. In reality, the patient’s husband was not waiting in the car for her. Approximately 1 hour after receiving medication, the patient drove herself home.
The patient was involved in a one-car accident 3 miles from the hospital 1 hour and 30 minutes after discharge and sustained serious brain injuries. She died 2 years later from delayed complications.
The Plaintiff’s Case
The plaintiffs expert witness stated that the standard of care for nurses is to visually verify the presence of someone who can assume responsibility for the patient’s care and well-being following narcotic medication administration. The expert further testified that the plaintiff was mentally and physically impaired by the extreme pain and narcotics: A patient with migraine pain may experience recurring global personality changes during extremely painful episodes, which can affect information processing, perception, memory, and judgment.
Two of the hospital’s nurses testified that their practice was to visually verify a driver before discharging a patient.
The Defense
A hospital physician testified that it is reasonable for nurses to accept the patient’s word that someone will drive him or her home.
The Outcome
The jury awarded the plaintiffs estate $1,263,000; however, the hospital and the plaintiff were each found 50% negligent. Consequently, the plaintiff’s estate received $634,500.
The Lesson for NPs
Clinicians should be cautious about accepting a patient’s word in a potentially dangerous situation, particularly if the patient could be drug impaired, pain impaired, or have questionable credibility. When the standard of care requires an escort to drive the patient home, clinicians must exercise the utmost care in effectuating safety measures for the welfare of the patient and others using the roadways. The clinician should meet the patient’s driver and confirm that he or she is competent to handle the patient. Finally, discharge instructions and the clinician’s phone number should be given to the driver.
ACKNOWLEDGMENT
The author thanks James Rodriguez, Esq., of Solar and Associates, Houston, Tex., for information on this case.
Cathy . Klein, MSN, MSEd, JD
Legal File Editor
Copyright Springhouse Corporation Jul 2001
Provided by ProQuest Information and Learning Company. All rights Reserved
