Chapter 5

1. Identify the ethical and legal issues present in this case.

Ethical Issues:

• Non-maleficence: Sarah’s primary duty is to do no harm to her clients. Administering the wrong medication dosage directly violated this principle.
• Fidelity: By not reporting the error and altering the medical records, Sarah violated the principle of fidelity, which emphasizes honesty and integrity in professional practice.
• Accountability: Nurses are ethically required to be accountable for their actions. Failing to report the medication error and falsifying records shows a lack of accountability.

Legal Issues:

• Negligence/Malpractice: Administering the wrong dosage of medication constitutes negligence, which can lead to malpractice claims.
• Falsification of Records: Altering medical records is a serious legal violation that can result in criminal charges and civil liabilities.
• Failure to Report: Not reporting a medication error is a breach of legal and professional duties, potentially leading to disciplinary actions by regulatory bodies.

2. How does Sarah’s behavior constitute professional misconduct?

• She failed to adhere to established medication administration protocols by not double-checking the doctor’s orders.
• She compromised client safety by administering the wrong medication dosage.
• She attempted to cover up her mistake by falsifying medical records, which is a severe breach of ethical and legal standards.
• She failed to report the medication error, preventing appropriate corrective actions from being taken and further endangering the client.

3. What are the potential consequences for Sarah, both professionally and legally?

Professional Consequences: Sarah could face disciplinary measures from the nursing board, including suspension or revocation of her nursing license. She might be terminated from her job due to her actions. Her professional reputation could be severely damaged, making it difficult to find future employment in the healthcare field.

Legal Consequences: Mr. Thompson or his family could file a malpractice lawsuit against Sarah, seeking compensation for the harm caused. Altering medical records is a criminal offense that could result in charges, leading to fines or imprisonment. Sarah could face civil penalties for her negligence and falsification of records.

4. How might the lack of adequate staffing and supervision have contributed to this incident?

Understaffing led to Sarah handling multiple clients at once, increasing the likelihood of errors due to the high workload and stress. Lack of adequate supervision might have left Sarah without the necessary support and guidance, contributing to her mistake and poor decision-making. The urgent call to assist another critical client likely pressured Sarah to act hastily, bypassing essential safety checks.

5. What policies should the hospital have in place to prevent such errors and ensure proper reporting?

Ensure sufficient staffing levels to reduce workload and stress, allowing nurses to follow protocols without rushing. Implement and enforce strict protocols for medication administration, including mandatory double-checking and verification processes. Establish non-punitive error reporting systems that encourage staff to report mistakes without fear of retribution, promoting a culture of transparency and learning. Provide ongoing training for staff on medication safety, error prevention, and ethical practices. Ensure adequate supervision and support for nurses, especially during busy or understaffed shifts.

6. How did Sarah’s actions affect Mr. Thompson’s safety and overall outcome?

Mr. Thompson’s condition worsened significantly due to the wrong medication dosage, directly affecting his health and requiring intensive care. The failure to report the error delayed appropriate medical intervention, further compromising Mr. Thompson’s safety and overall outcome. The altered medical records could have led to further incorrect treatments or misdiagnoses, increasing the risk to Mr. Thompson’s health.

7. What impact might this incident have on the trust between healthcare professionals and clients?

Clients rely on health care professionals to provide safe and honest care. Incidents like this erode client trust in their caregivers and the health care system as a whole. Clients might become reluctant to seek care or follow medical advice, fearing potential errors and lack of transparency. Such incidents can damage the trust and collaboration among healthcare professionals, leading to a less cohesive and effective team dynamic.

End of Chapter Learning Activities