A home healthcare infusion nurse is concerned about one of her RN colleagues. This colleague documented that she infused a medication for a home care patient in contradiction to the directions on the infusion bag from the home infusion pharmacy.

Specifically, this RN documented that she administered the ordered medication over two-and-a-half hours rather than the four hours directed on the bag.

The infusion nurse wonders who would be liable if this or another patient was injured or died due to her colleague ignoring ordered infusion rates, and should she do something about her colleague’s conduct.

Is Home Infusion Nurse Liable?

The home infusion nurse’s concerns are valid. There is no doubt that there would be legal liability for the colleague who ignored the prescribed infusion time. Liability would rest on a violation of standards of care and standards of practice for infusion therapy under a professional negligence or wrongful death allegation. In addition, she would most likely face professional disciplinary action by the state board of nursing.

Also, the infusion nurse would face legal liability if she did not report the information about her colleague. The nurse administrator of the home health agency needs to be informed that the RN’s administration of the infusion was in violation of the ordered prescription.

The nurse administrator can then take whatever action is necessary to prevent this from happening again. If required action is not taken (e.g., agency discipline, termination), the nurse administrator may be named in a lawsuit for not protecting patient safety when knowing of this nurse staff member’s actions.

Reporting to the Board

Another required action the nurse administrator and the RN infusion nurse must evaluate is reporting the offending nurse to the state board of nursing. Nurse practice acts and rules require nurse licensees to report conduct that is unsafe to appropriate authorities, including to the board itself.

The home infusion pharmacist also faces potential liability in this situation. According to the American Society of Hospital Pharmacists (ASHP), a home infusion pharmacist is responsible for, among other things, clinical monitoring, care planning, and the assessment of home infusion patients. This most probably includes reviewing nursing notes and other aspects of the patient’s medical record.

If such a review was not done or if the pharmacist knew (or should have known) that the nurse ignored prescribed infusion rates and did nothing about it, the pharmacist could be named in a lawsuit and face possible disciplinary action by the state board of pharmacy.

Don’t forget that the home infusion therapy agency and the home infusion pharmacy organization could also be named in a lawsuit and may also be reviewed for whether continued good standing status by their respective business licensing boards and accreditation bodies is warranted.

Keep These Points in Mind

This scenario encompasses one of the basic principles of legal liability: You are accountable and responsible for your own conduct. As a result, when you discover behavior that threatens the safety and health of a patient, you have a legal (and ethical) obligation to eliminate that threat.

Although the infusion nurse only has knowledge of this one particular incident, she has to wonder (as would the other infusion team members) if the RN has been ignoring infusion rates with other patients.

The nursing home care administrator has an obligation to fairly investigate the RN’s conduct. Reviewing the RN’s documentation of other patients that the RN cared for will be necessary in order to determine exactly what discipline will be imposed based on the agency’s disciplinary policy.

The results of the internal investigation will then dictate the nursing administrator’s other reporting obligations, as discussed earlier.

Infusion nurses should:

  1. Never change an ordered infusion rate without contacting the pharmacy and obtaining a new prescription.
  2. Carefully monitor a patient who is receiving infusion therapy.
  3. Document your observations, patient care, and other treatment accurately and completely.
  4. Establish and maintain open communication with other infusion team members, including the home infusion pharmacy.

When confronted with a colleague’s conduct that compromises a patient’s safety and well-being, take whatever actions are available to you to rectify the risk to the patient.

 

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