Adverse Drug Reaction: Nurse Negligent Not Clarify Orders And To Give Patient's At-Home Meds

Adverse Drug Reaction: Nurse Negligent Not Clarify Orders And To Give Patient's At-Home Meds

Legal Eagle Eye Newsletter for the Nursing Profession

December 1997

Quick Summary: The physician's order meant no at-home meds. The nurse should have clarified what the order meant.

The patient came to the emergency room with a swollen tongue and with difficulty swallowing. The physician believed it was an allergic reaction to his blood pressure medication.

   The physician told the patient’s wife to go home, get all the patient’s medications, bring them in and leave them at the nurse’s station.

   The nurse on duty believed this meant he was supposed to continue to give the patient’s at-home medications while the patient was in the hospital, including the blood pressure medication, even though the physician had diagnosed an adverse drug reaction to the blood pressure medication.

   There was confusion over the meaning of the NPO order entered by the physician in the chart.

NPO means "nothing by mouth." It could be taken to mean only that the patient was to get no food, water or beverages, or it could be taken more literally to mean the patient was to receive no food or drink or any oral medications. COURT OF APPEALS OF GEORGIA, 1997.

A patient came in to the emergency room with complaints the physician attributed to his Zestril. The physician ordered intensive care, told the patient’s wife to go home and bring in all the patient’s at-home medications and leave them at the nurse’s station, and wrote and order the patient would be "NPO."

At 4:00 a.m. a nurse gave the patient the Zestril which the wife had brought in two hours earlier, even though the physician had diagnosed the patient as having experienced a life-threatening allergic reaction to that medication. The patient went home that afternoon, had the same allergic reaction in the middle of the night, and this time he died.

The nurse apparently believed the patient’s at-home medications had been brought in so the patient could continue to get them in the hospital. The nurse testified he had been verbally instructed by the physician to do this.

The Court of Appeals of Georgia ruled that under these circumstances there was evidence of negligence by the nurse which made the hospital’s efforts to be dismissed from the lawsuit ill taken. The nurse’s agency would be let out of the case, as the hospital alone had supervisory control over his actions at the time in question.

The court believed there was probably some confusion over the NPO order. A physician writing such an order might intend it to mean the patient was to receive no food, no drink and no oral medications, while another healthcare professional reading the same order might interpret it to apply only to food and drink, but not to apply one way or the other to oral medications. And there was no direct statement in the chart by the physician that the patient was not to receive his usual at-home dosage of his blood pressure medication. But the court still did not absolve the nurse from blame. Brown vs. Staffing, 490 S.E. 2d 503 (Ga. App., 1997).