Failing to adequately monitor patients heads the list of nursing-related errors.


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Making an error that harms a patient is every nurse's nightmare. Being sued for it compounds the issue, though this doesn't happen often. According to a recent analysis of malpractice claims, nursing personnel were involved in only 18% of the claims, and only 2% of these specifically named a nurse as a defendant. While that may seem like good news, the report, A Nurse's Crucial Role in Patient Safety: Through the Lens of Malpractice Claims, emphasizes that nearly half of the claims involving nursing resulted in severe injuries to patients or death.

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The analysis-by Coverys, a medical professional liability insurer-was undertaken to identify trends and root causes of nursing malpractice events. Analysts reviewed 4,634 malpractice claims settled between 2018 and 2021. Of these cases, 850 (18%) of the adverse events directly involved nursing personnel, including RNs, LPNs, nursing assistants, and nursing students. The majority of nursing-related errors (65%) occurred in inpatient settings, with 66% of them taking place in the patient's room.


Of the 850 nursing-involved events, 45% were related to patient monitoring, 18% to medication administration, 14% to patient falls, and 10% to pressure injuries. Contributing factors included lack of cohesion in the clinical team; poor communication between RNs and physicians; dysfunctional organizational cultures; inadequate staffing; poor workplace design; and distractions during care delivery, such as medication dosing and administration.


The report places special emphasis on nursing's role in monitoring patients, highlighting transitional periods when close monitoring is critically important to patients' well-being. These include when newly admitted patients are assessed or when patients are transferred between units, as well as in the early postoperative period. Of malpractice events attributed to lapses in monitoring, almost half (49%) resulted in death, largely due to pressure injuries, sepsis, and cardiovascular events.


Commenting on the report, Edie Brous, a nurse attorney and contributing editor of AJN, said it echoes her experiences in representing nurses accused of malpractice. "The most frequent legal actions involving nurses are medication errors, falls, and failure to observe and report, which involves nurses not monitoring patients for foreseeable complications, not recognizing what they are seeing, and not reporting adverse changes or pursuing their concerns to resolution." Brous emphasized that nursing documentation needs to be specific and comprehensive, including "who was told what, when they were told, and their responses all the way up the chain of command until the issue is taken care of." She added: "Vague charting like 'MD aware' or 'supervisor aware' doesn't relieve the RN of responsibility and won't hold up in court or a nursing board investigation."


Along with an analysis of nursing-related errors, the Coverys report offers strategies and action steps for organizations and individual nurses to decrease malpractice risk and increase patient safety. Organizations should foster a workplace culture that supports safe practice, cohesive teamwork, and blameless reporting of errors and near misses, and utilizes evidence-based tools to enhance communication within the clinical team. Nurses should be vigilant and attentive in their interactions with patients, forestall interruptions and distractions when administering medications or performing other clinical tasks, and thoroughly communicate findings to colleagues. The report is available at http://www.coverys.com/knowledge-center/a-dose-of-insight-nurses-patient-safety.-Maureen Shawn Kennedy, MA, RN, FAAN