What Are the Consequences of Violating Medication Policies?

Carolyn Buppert, NP, JD

Disclosures

December 27, 2011

Question

What "law," if any, applies if nurses do not follow policy and procedure with medication administration? For example, a nurse might document medications at one time but administer them much later.

Response from Carolyn Buppert, NP, JD
Attorney, Law Office of Carolyn Buppert, PC, Bethesda, Maryland

A nurse who documents that he or she administered a medication at 1:00 pm but actually administered the medication at 4:00 pm could be endangering the patient. The assumption to anyone reading the patient's chart is that the medication was administered at the time the nurse documented it as given. Patient response and diagnostic test results will be evaluated using that assumption. Future doses will be given on the basis of the assumption that the last dose was given on time. If a medication is given too close to the next dose, or too far from the last dose, the blood level of the drug is unlikely to be what the ordering clinician is counting on in his or her plan of care.

To intentionally misstate the administration time is a breach of the standard of care and standard of practice and is an ethical breach as well. Nurse Practice Acts specify the general standards of practice and of ethical conduct for nurses, and a nurse who doesn't meet the standards may be disciplined through the Board of Nursing. For example under Maryland's Standards of Practice for Registered Nurses, "the RN shall implement the interventions identified in the plan of care.... interventions shall be...consistent with the established plan of care; [and] implemented in a competent, safe, and appropriate manner consistent with knowledge of scientific principles...."[1] Maryland's ethical code of conduct says, "A nurse may not, when acting in the capacity or identity of a licensed nurse...knowingly participate in or condone dishonesty, fraud, deceit, or misrepresentation."[1]

In addition, administering a medication on a time table other than what the prescribing clinician ordered would be making a change in the medical treatment, which would exceed the scope of practice of a registered nurse.

Furthermore, to intentionally misstate the administration time is to falsify the record. Falsification of records is a violation of the Nurse Practice Act in every state. On the Maryland Board of Nursing Website there is a report of a case in which a nurse's license was revoked after the nurse falsified records.

Hospital policies usually state that a nurse must give a medication within 1 hour of the time specified in the order. When a medication is not given within that time frame, a nurse is expected to note that the dose was not given on time and ask the patient's clinician with prescribing authority what to do about it. The prescribing clinician can decide whether to give the dose late and adjust the timing of future doses, skip the dose, or double up by giving the dose late and the next dose on time.

A nurse who doesn't follow hospital policy on medication administration can be disciplined within the facility or reported to the Board of Nursing for disciplinary action. If a patient suffers an injury as a result of a nurse's breach of the standard of care, the patient could sue the nurse for malpractice.

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