When the ambulance arrived , the RN gave a brief report of the patient ’ s medical history and the medications he had given the patient that morning , which included flecainide 1.3 mL . At this time , the RN realized that he had administered the incorrect dosage . The RN called the patient ’ s mother and advised her of the medication error ( administering 25 mL of flecainide instead of 1.3 mL ). The RN proceeded to the ED and arrived approximately 10 minutes after the ambulance . The RN informed the ED providers of the medication error , and a serum toxicology test was ordered to confirm the error . The patient was admitted to the intensive care unit , and despite all life-saving efforts , she died soon thereafter .
Lawsuit Following the patient ’ s death , the mother ( plaintiff ) filed a lawsuit against the RN and the home healthcare agency . The allegations against the RN included :
• Failure to properly administer the correct and prescribed dosage of flecainide to the patient and a conscious disregard of the known risk of flecainide toxicity and overdose .
• Administering an improper , excessive dose of flecainide medication in an amount more than 19 times the prescribed dosage and with a conscious disregard of the known risk of flecainide toxicity and overdose .
• Failure to review , confirm , and adhere to the prescribed documentation regarding the medications .
• Failing to confirm and verify the correct dosage of flecainide that was prescribed to be administered to the patient .
• Failure to adhere to proper policies , procedures , or guidelines regarding the administration of prescribed medications to the patient .
Risk Management Comments The cardiology expert for the defense opined that the life expectancy of the patient was six months or less due to her severe hemodynamic instability . The defense ’ s neuro-oncology expert testified that there was no chance for the patient ’ s full recovery due to the extensive treatment of her metastatic cancer and estimated that the patient ’ s life expectancy was much less than six months .
Irrespective of the patient ’ s life expectancy , it was determined that defense of the RN would be difficult due to the egregious nature of the medication error .
An additional concern was that the RN was a poor witness at his deposition . Despite being prepared by the defense team , the RN lacked confidence during his testimony and contradicted himself many times . At one point in the deposition , the RN testified to knowing that he was administering an excessive amount of flecainide but proceeded to do so anyway .
Resolution The mother was represented by a high-powered and aggressive law firm . The defense believed that when a jury learned of the RN ’ s disregard of medication safety , they might choose to award a large verdict to the plaintiff for the emotional loss of a beloved daughter , despite the patient ’ s pre-existing , severe condition . Therefore , the decision was made to settle the case on behalf of the RN . The indemnity payment and legal expenses totaled more than $ 1,000,000 . ( Note : Monetary amounts represent the expenses made solely on behalf of the individually insured RN and do not reflect payments made on behalf of any other parties who may have been involved in the claim . Amounts paid on behalf of other co-defendants named in the case are not available .)
Conclusion : Risk Control Recommendations Medication safety has become a highly prominent issue , as national patient safety initiatives focus upon practitioners ’ attention regarding the necessity to improve medication management and error reporting processes ( Institute for Safe Medication Practices [ ISMP ], 2022a ). However , dispensing and administration lapses , which are often difficult to defend in the event of a malpractice claim , continue to occur . By following the suggested actions , among others , nurses can assist in reducing the liability associated with medication errors :
30 NSNA IMPRINT • NOVEMBER / DECEMBER 2022 • www . nsna . org