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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.