Case study : Ethical Medication Errors in Healthcare

Assignment Task

Case

Andrea is employed at a long-term care facility. For each shift, there is one nurse on duty for 40 patients. The major nursing responsibility is to give medications to patients. On average, patients have 10 medications each. Andrea must take the blood sugar readings of 10 residents every morning, because they are on sliding-scale insulin orders. The personal support workers provide hands-on care for the patients. Andrea has told her unit manager that she is overworked. She recommends that the institution get unit-dosing and employ more registered nurses and registered practical nurses for safety reasons. Her manager says these options are too costly. Andrea replies that she will not continue to work under these conditions. She submits her resignation, giving her employer two weeks' notice. That night, the evening nurse calls in sick. The unit manager tells Andrea she must stay until he can find an agency nurse to replace her. Andrea says she is not happy about this, but she will stay because she does not want the patients to be without a nurse. Andrea administers the evening medications and leaves when a replacement registered nurse arrives at 2200 hours. When she returns to work the next day, Andrea finds the coroner is present because a new resident died during the night. The resident, Mrs. Smith, had a respiratory arrest; CPR was given, but she did not survive. Andrea looks at the medication record with the coroner. It is clear from the narcotic count that she had given Mrs. Smith 100 mg of morphine and not 10 mg, as ordered.

Questions

1. After being shown the documentation in the narcotic count book, Andrea sees that she made an error when administering Mrs. Smith's medication. Do you think Andrea is fully responsible for the patient's death, or were there mitigating circumstances? What should Andrea say and do when asked about her care of Mrs. Smith? 
2. Under what circumstances are coroners required to investigate a death? Should the coroner have been called in this case? After the coroner makes a report, what are the next steps? How will Andrea be involved in the coroner's report and any further actions? 
3. The family thinks Mrs. Smith's death was preventable. They complain to the college and consider using litigation. What resources are available to assist in Andrea responding to charges of professional misconduct and malpractice, and a criminal charge? and a criminal charge?

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