Assuming the patient can read and understand the medication instructions, there is no reason to require the nurse to read the instructions to the patient.  The physician must warn the patient of potential drug reactions and interactions.  COURT OF APPEALS OF WASHINGTON, 1999.

   The patient came to the emergency room with a sore toe. As part of his history the physician learned he was taking heparin. She diagnosed the toe problem as gouty arthritis and prescribed indomethacin.

   The emergency room nurse handed the patient his indomethacin from the pharmacy and the hospital’s printed discharge instructions. The discharge instructions contained a warning against patients with blood clotting disorders taking indomethacin.

   Two weeks later he had a pulmonary hemorrhage. He sued the hospital, physician, pharmacist and nurse for malpractice. The Court of Appeals of Washington threw out the case.

   The patient’s nursing expert witness argued that the standard of care for nursing is for a discharge nurse personally to go over the hospital’s printed discharge instructions and to discuss potential medication complications with the patient.

   The court disagreed. A nurse cautioning a patient against taking the medication the physician has ordered would impermissibly interfere with the physician-patient relationship, the court felt. The physician wanted this patient to take the indomethacin. And the court said it is the physician’s duty, not the nurse’s, to make the judgment how to warn the patient of possible drug reactions and interactions.

   If the patient has read and signed the discharge instructions, the nurse’s duty has been fulfilled, the court ruled. Silves v. King, 970 P. 2d 790 (Wash. App., 1999).