Misconduct is an action that may compromise the career of a nurse, but can be defended properly by a nurse attorney should the nurse provides a good reason. This is a matter that should be defended properly, especially if the RN or LVN values their career. If the nurse attorney is more experienced, the better defense the nurse may receive.
The instances of medical malpractice occurred to a LVN in Dallas. At the time of the initial incident, the LVN was employed as a Charge Nurse and had been in this position for only four months.
On or about December 31, 2008, the LVN inappropriately administered intramuscular Valium to a patient, who was having a seizure,without a physician’s order. Although there was injectable Valium with a label dated September 19, 2007, a current physician’s order for Valium was not in the medical record. Additionally, she administered Ativan, at least once, without clarifying the route and frequency with the physician. The LVN’s conduct was likely to injure the resident from non-efficacious treatment and/or adverse reactions due to medications administered without a current, complete physician’s order.
On or about January 9, 2009, through January 30, 2009, the LVN inappropriately administered Ativan I mg via G-tube to a patient fifteen times for treatment of anxiety or agitation, without a physician’s order for this indication. The physician had only ordered Ativan to be administered as needed for a seizure. The LVN’s conduct was likely to injure the resident from non-efficacious treatment and/or· adverse reactions due to medications administered without the benefit of a physician’s care or expertise.
On or about February 23, 2009, the LVN again inappropriately- administered intramuscular Valium to a patient, who was having a seizure, without a physician’s order. Additionally, she administered Ativan, which was expired, without clarifying the route and frequency with the physician prior to administration. She failed to inform the physician of the resident’s status, the medications administered, and the resident’s transfer to the hospital. Her conduct was likely to injure the resident from non-efficacious treatment and adverse reactions due to medications administered without a current, complete physician’s order, and deprived the physician of necessary information on which to base care decisions.
On or about December 31, 2008, through February 23, 2009, the LVN failed to accurately and completely document in the medical record of a patient, as follows:
- On December 31, 2008, she documented that she administered Ativan once in the Nurse’s Notes and Medication Administration Record (MAR), but documented that Ativan was administrated twice on the Resident Transfer Record;
- She failed to document obtaining-the injectable Ativan on the Individual Control Drug Records in December 2008 and February 2009;
- She documented instructions for administration of Ativan on the MAR in December 2008, without an actual order from the physician; an
- On February 23, 2009, Respondent failed to document the resident’s seizure, and when she documented a late entry on February 24, 2010, she dated the entry February 23, 2010, instead of noting the correct date and that it was a late entry for the previous day.
The LVN’s conduct resulted in an incomplete, inaccurate medical record, was likely to injure the resident in that subsequent care givers would not have complete information on which to base their care decisions, and placed the hospital in violation of Chapter 481 of the Texas Health and Safety Code (Controlled Substances Act).
The LVN was given the chance to defend herself. She states that she was called to the room of a patient, who was having a continuous seizure with no periods of rest, and the Assistant Director of Nursing (ADON) checked the MAR while she retrieved the resident’s seizure medications, with which she was familiar since the resident had experienced a seizure during the previous month. According to the LVN, the ADON stated that Valium had mistakenly been omitted from the MAR upon the resident’s readmission from the hospital, that the Ativan order was not complete, and that she would notify the resident’s physician about the situation, obtain an order for Valium, and obtain clarification of the Ativan order.
The LVN further explains that she overlooked the expiration date of the Ati van because she was concerned about the resident’s well-being and did not intentionally administer an expired medication. Due to the facility’s mandate regarding work hours, she states she was unable to document in the medical record of a patient before her work shift ended. She states that she returned to the facility the following day and documented a late entry regarding the seizure episode of Resident DD. The LVN concludes that the situation was a horrific nightmare for her, especially in her first year of nursing, and that she has learned a valuable lesson from her error in judgement.
The Texas Board of Nursing then decided to subject the LVN and her license into disciplinary proceedings. The said proceedings shall ensure the safety of the patient, along with a better future for the LVN’s career. However, she should contact a nurse attorney in order to receive assistance regarding the case, especially if the LVN sincerely thinks of it as an accusation.
For more details or for a confidential consultation regarding accusations, it’s best to contact an experienced nurse attorney. Yong J. An is an experienced nurse attorney which helped RNs and LVNs defend against many cases since 2006. You can call him at (832)-428-5679 to get started or to inquire for more information regarding nursing license case defenses.