A Physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug and the patient has an allergic reaction. Medication order finds that patient is allergic to penicillin. Legal responsibility for this?

1. A

   Only the nurse

2. B

   Only the physician

3. C

   Only the pharmacist

4. D

   All are liable for mistake

Appeared in: NHM MP Staff Nurse - 2015

Explanation

• Patient safety is a shared responsibility, and medication administration involves a multi-step process with checks and balances.
• The physician committed the initial error by prescribing a drug to which the patient had a known allergy.
• The pharmacist, who is responsible for reviewing and dispensing medications, failed to catch the physician's error.
• The nurse is the final safety check in the medication administration process and has a legal and ethical duty to verify allergies and question any order that may cause harm.
• Since all three professionals breached their duty of care, they are all considered legally liable for the mistake.

Why Other Options Were Wrong

• Option A: While the nurse is liable, the responsibility is not solely theirs. The error originated with the prescriber and was also missed by the pharmacist.
• Option B: The physician initiated the error, but the pharmacist and nurse had subsequent professional duties to act as safety checks. Their failure to do so contributes to the liability.
• Option C: The pharmacist shares liability for not verifying the prescription against the patient's allergies, but they did not create the initial incorrect order, and the nurse had the final chance to prevent the error.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Shared liability and professional accountability in medication administration to guide bedside assessment, documentation, and the next nursing action.
• This scenario highlights the absolute necessity of adhering to the 'Five Rights' of medication administration: Right Patient, Right Drug, Right Dose, Right Route, and Right Time. Allergy verification is a key part of the 'Right Assessment' and 'Right Drug'.
• Nurses must cultivate a questioning attitude and feel empowered to challenge any order that seems incorrect or potentially harmful. Never assume a prescription is correct just because it was written by a physician and dispensed by a pharmacist.
• What if? If the patient was unconscious or non-verbal, the nurse's responsibility to meticulously check the medical record, patient chart, and allergy wristband would be even more critical, as direct confirmation from the patient would be impossible.

How to Approach the Question

• First, identify the core event: a medication error occurred, resulting in patient harm (an allergic reaction).
• Next, identify all the healthcare professionals involved in the medication process: the prescriber (physician), the dispenser (pharmacist), and the administrator (nurse).
• Consider the professional and legal duties of each role. Each professional has a responsibility to ensure patient safety at their step of the process.
• Apply the principle of shared responsibility. In a multi-step system like medication administration, when multiple safety checks fail, liability is typically shared among those who failed to perform their duty.
• Evaluate the options based on this principle. Options that assign blame to a single individual are less likely to be correct in a scenario depicting a systemic failure.

Concept Tested & Keywords

• Concept Tested: Shared liability and professional accountability in medication administration.
• Stem keywords: medication error, penicillin, allergic reaction, legal responsibility
• Lead-in keywords: Legal responsibility
• Clinical cues: Known allergy was documented, which is a key factor in determining negligence.
• Negative lead-in flag: false

Question ID

QJroysItGA0QVOzb2PY7bk

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 847-849

E6 Pharmacology Nursing Lilley 11e Part 1 p. 88-90