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chapter 3 | Nursing Practice and the Law 29 CikguOnline
table 3-1
Common Causes of Negligence
Problem Prevention
Client falls Identify clients at risk.
Place notices about fall precautions.
Follow institutional policies on the use of restraints.
Always be sure beds are in their lowest positions.
Use side rails appropriately.
Equipment injuries Check thermostats and temperature in equipment used for heat or cold application.
Check wiring on all electrical equipment.
Failure to monitor Observe IV infusion sites as directed by institutional policy.
Obtain and record vital signs, urinary output, cardiac status, etc., as directed by institutional
policy and more often if client condition dictates.
Check pertinent laboratory values.
Failure to communicate Report pertinent changes in client status.
Document changes accurately.
Document communication with appropriate source.
Medication errors Follow the Seven Rights.
Monitor client responses.
Check client medications for multiple drugs for the same actions.

did not do whatever needed to be done. If a nurse all clients for a shift before the medications are
did not “do” something, that leaves the nurse open administered, a nurse is leaving himself or herself
to negligence or malpractice charges. open to charges of medication error.
Nursing documentation needs to be legally In the case of Mr. Harrison, the institutional
credible. Legally credible documentation is an personnel were found negligent because of a direct
accurate accounting of the care the client received. violation of the institution’s standards regarding the
It also indicates the competence of the individual application of restraints.
who delivered the care. Nursing units are busy and often understaffed.
Charting by exception creates defense difficul- These realities exist but should not be allowed to
ties. When this method of documentation is used, interfere with the safe delivery of health care.
investigators need to review the entire patient Clients have a right to safe and effective health
record in an attempt to reconstruct the care given to care, and nurses have an obligation to deliver
the client. Clear, concise, and accurate documenta- this care.
tion helps nurses when they are named in lawsuits.
Often, this documentation clears the individual of Common Actions Leading
any negligence or malpractice. Documentation is to Malpractice Suits
credible when it is: ■ Failure to assess a client appropriately
■ Failure to report changes in client status to the
■ Contemporaneous (documenting at the time
appropriate personnel
care was provided)
■ Failure to document in the patient record
■ Accurate (documenting exactly what was done)
■ Altering or falsifying a patient record
■ Truthful (documenting only what was done)
■ Failure to obtain informed consent
■ Appropriate (documenting only what could be
■ Failure to report a coworker’s negligence or poor
discussed comfortably in a public setting)
practice
Box 3-2 lists some documentation tips. ■ Failure to provide appropriate education to a
Marcos,the nursing student earlier in the chapter, client and/or family members
violated the right-dose principle and therefore made ■ Violation of internal or external standards of
a medication error. By signing off on medications for practice