Vicarious corporate liability and employee negligence in organizational lawsuits

Norton v. Argonaut Insurance Company, there was a staffing shortage on a pediatric ward of Baton Rouge General Hospital. An administrative nurse was filling in for the regular pediatric nurse, and carried out the physician's order which read, "Give 3.0 cc lanoxin today for one dose only." The nurse did not contact the physician to confirm the directions and her previous experience had been with injectable Lanoxin only. She gave the dose intramuscularly instead of orally, as intended, and the infant died. The nurse was found negligent for administering medication in which she was unfamiliar and for neglecting to clarify the order the prescribing physician. The nurse questioned two physicians who were not treating the infant, but failed to mention that the order was written for elixir of Lanoxin. The nurse, the original physician and the hospital were found liable (Norton v Argonaut, 1962).

Mistakes in the Situation- Nurses have a duty to question a medication order that might be unclear, unusual, or out of the norm for the patient's age and circumstances. The physician should have clarified the order with the nurse, knowing that she was not a regular pediatric nurse, and/or had been away from actual dosage prescribing for children for a while. The nurse should have clarified the order with the physician, and/or when she talked with other physicians about the order, she should have been clearer about the manner in which the order was written and any specific concerns she might have.

Steps to Prevention- Within the medical profession a number of safeguards and checks are already in place that minimize errors. Since most medical errors are from medication errors, most of the overall errors can be prevented by checking records to ensure patient is correct, age, weight and dosage are correct; use of ID bracelets to confirm identity and physician's orders; use handheld computers to check for harmful drug interactions; being clear with handwriting and double-checking dosage; pharmacists or nurse clearly warn patients about certain reactions (e.g. take with food, no excessive sunlight, no alcohol, etc.). Patient or EMRs need to be thorough in advising physician of drugs, including OTC and vitamin supplements, patient is taking. Have a system in place in the hospital atmosphere that is a simple double check -- ensure open and honest communication between patient, nurse, and physician (Aetna, 2012).