When a medication reaches the patient’s bedside, the responsibility for its safe delivery shifts to the person physically administering it. In Georgia, medication administration errors are evaluated under the nursing standard of care as established by common law: the administering professional must exercise the degree of care and skill that a reasonably competent peer would apply under the same circumstances. The scope of this discussion is limited to the physical act of delivering a medication to a patient. Prescribing decisions, drug interaction analysis, and the physician’s role in medication selection are distinct subjects addressed elsewhere.
The Categories of Administration Error
Medication administration errors fall into recognized categories, each representing a failure at a different point in the delivery process. The most commonly identified categories include wrong dose, wrong time, wrong patient, and wrong route.
A wrong-dose error occurs when the patient receives a quantity of medication that differs from what was prescribed. This can involve administering too much or too little of the correct drug. A wrong-time error occurs when medication is delivered outside the window specified by the prescribing order, potentially disrupting the therapeutic schedule or creating dangerous overlaps with other medications. A wrong-patient error occurs when a medication intended for one patient is delivered to a different patient, exposing the recipient to a drug that was neither prescribed for them nor appropriate to their clinical situation. A wrong-route error occurs when a medication is delivered through an unintended pathway, such as administering an oral medication intravenously, or vice versa, which can alter absorption rates and produce effects dramatically different from those intended.
Each of these error types involves a departure from the same core obligation: the administering professional must verify that what they are delivering matches what was ordered, for the patient to whom it was ordered, through the route that was ordered, at the time it was ordered.
The Nurse’s Duty to Verify Known Allergies
Before administering any medication, the nurse or administering professional has an independent duty to check the patient’s documented allergy status. This duty exists separately from the prescribing physician’s responsibility to avoid ordering contraindicated drugs. Even if the physician has prescribed a medication to which the patient has a documented allergy, the administering professional is expected to recognize the conflict and take appropriate action before delivery.
This verification obligation reflects the position of the administering professional as the final checkpoint in the medication delivery chain. By the time a drug reaches the bedside, the prescribing decision has already been made and the pharmacy has already dispensed the product. The nurse who physically delivers the medication is the last person with an opportunity to intercept an error before it reaches the patient. Georgia’s common law standard of care expects the administering professional to fulfill that checkpoint function.
The duty encompasses reviewing the patient’s chart for documented allergies, confirming allergy information with the patient when feasible, and cross-referencing the prescribed medication against known sensitivities. A nurse who administers a drug to a patient with a documented allergy to that drug, without addressing the conflict, has failed to meet the expected verification standard.
Charting and Documentation
Documentation plays a dual role in medication administration cases. First, it is the mechanism through which the administering professional records what was given, when, by what route, and at what dose. Accurate contemporaneous documentation creates a verifiable record that the administration matched the prescription order. Second, when errors occur, the documentation, or its absence, becomes central to the evidentiary analysis.
A charting gap, where a medication is administered but not recorded, or recorded inaccurately, can indicate a breakdown in the processes that are designed to ensure safe delivery. Similarly, documentation that records an administration event but omits required verification steps, such as allergy confirmation or dose cross-checking, can suggest that those steps were not performed.
The standard of care requires that medication administration be documented contemporaneously, meaning at or near the time of delivery rather than reconstructed from memory hours later. The rationale is practical: real-time documentation reduces the risk of omission and ensures that the next provider to interact with the patient has an accurate, current picture of what medications have been delivered.
Consider a scenario where a patient’s prescription order specifies a particular dose of a medication. The administering nurse delivers a dose that is twice the prescribed amount. The patient experiences an adverse reaction consistent with overdose of that specific drug. The claim would allege that a competent administering professional would have verified the dose against the prescription order before delivery and that the failure to do so, resulting in administration of the incorrect dose, caused the adverse reaction.
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Disclaimer
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