The patient’s nursing expert faulted the hospital for still using an outdated source for its protocol for intramuscular injections.

  The hospital’s reliance on an outdated nursing text, according to the patient’s expert, was a breach of the legal standard of care.

  The outdated source did not specify a maximum volume for an injection into the deltoid muscle.

  The hospital’s standing protocol nevertheless placed a limit of 5 ml on injections into the deltoid.

  Nursing texts current at the time the patient received the injection into her deltoid muscle did specify a maximum volume.

  Nursing texts current at the time of the patient’s injection limited injections into the deltoid to 0.5 to 1 ml of fluid, much less than the volume allowed by the hospital and less than that actually given by the emergency department nurse.

  The nurse injected 60 mg of Toradol in 2 ml of fluid.

  The patient still must convince a jury through expert medical testimony that the Toradol injection was the actual cause of the symptoms she has experienced since the incident in the hospital’s emergency room.  COURT OF APPEALS OF TEXAS June 29, 2015

  The patient came to the emergency department complaining of knee pain.  The physician diagnosed a knee strain and ordered 60 mg of Toradol IM.

  The patient received an IM injection from the emergency department nurse in the left deltoid of 60 mg of Toradol in 2 ml of fluid.

  Immediately afterward the patient felt pain radiating up and down the arm.  The next day there was pain, swelling, tingling, spasms and weakness in the arm.

  An orthopedist eventually diagnosed complex regional pain syndrome post Toradol injection. 

  The hospital’s protocol was last updated two and one-half years before.

  Based on the fifth edition of a standard nursing text which did not specify a maximum volume for injections into the deltoid muscle, the hospital’s protocol specified a maximum volume of 5 ml for injections into the deltoid.

  However, the seventh edition of that same nursing text and other nursing texts current in June 2011 when the patient was treated limited injections into the deltoid to 0.5 to 1 ml.  Larger volume injections were to be given in a larger muscle in the ventrogluteal region.

  The Court of Appeals of Texas accepted the patient’s nursing expert’s opinion that the hospital’s protocol for intramuscular injections violated the legal standard of care, in that the protocol was based on an outdated nursing text.

  The Court threw out the local county judicial court’s ruling which erroneously granted a summary judgment of no liability in favor of the hospital.

  However, before the patient will be entitled to an award of damages from the hospital the patient’s attorneys will have to convince a jury to accept her expert physician’s opinion that her symptoms after the incident were in fact caused by the Toradol injection and not some other factor.  Bowser v. Craig, 2015 WL 3946371 (Tex. App., June 29, 2015).

More references from nursinglaw.com

http://www.nursinglaw.com/iminject.htm

http://www.nursinglaw.com/IM-injection-nurse-testimony.pdf

http://www.nursinglaw.com/injection1.htm