The Centers for Medicare and Medicaid Services recently issued a violation citation to CHI St. Luke’s Health—The Woodlands Hospital. This 231-bed hospital is located in Montgomery County, at 17200 St. Luke’s Way, The Woodlands, TX 77384. The Medicare health inspector visited CHI St. Luke’s Health—The Woodlands Hospital on March 20, 2018, and cited the hospital for a violation of patient rights to participate in care planning.
As a former hospital administrator, I was interested to learn that the hospital had its own internal policy on pain management, which the nursing staff didn’t follow in this case. The hospital’s pain management policy requires nurses to assess and document patient pain, using a pain score to determine the medication and dose selected. The policy also requires nurses to reassess the patient within one hour after giving a pain medication to see if there has been a change in patient condition.
After investigating medical records, the inspector found that a patient had received pain medication on five occasions without a pain scale being documented or re-evaluated within an hour after administration. The powerful narcotic pain medications being administered included hydrocodone-acetaminophen (Norco) and morphine.
Why reassessment after pain medication is important
When nurses give a pain medication, but don’t reassess the patient afterwards, it creates an unnecessary danger to the patient.
This reminds me of a medical malpractice wrongful death lawsuit in which I represented the family of an elderly lady who was overmedicated with pain medication after back surgery.
The orthopedic surgeon and hospitalist physician ordered the nursing staff to give the patient powerful narcotic pain medications on a schedule of every four hours (as opposed to “as needed” or “PRN”). This lady was rather small, and the painkillers made her very sleepy and almost unconscious. Yet, the nurses continued to give the painkillers without reassessing her or questioning whether she even needed them.
As a result, the lady passed out, which caused her to lose control of her airway. The painkillers also, separately, caused her to become nauseated. While she was passed out, she threw up and then swallowed the vomit, causing aspiration pneumonia that took her life a short time afterward.
Nurses play an important role in patient safety
In my experience as a Houston, Texas, medical malpractice attorney, I have seen many instances where hospitals express a rather low opinion of the competence of their nurses. In cases where nursing conduct is at issue, these hospitals try to defend themselves by making it sound like nurses are poorly educated and marginally competent and have few responsibilities.
Nothing could be further from the truth. In addition to being the “eyes and ears” of doctors who aren’t always present in the hospital, nurses owe an independent duty to patients. One of them is described in the Texas Board of Nursing rules, which require nurses to understand the rationale and effects of medications that they administer.
While it’s true that a registered nurse cannot prescribe a medication—that’s up to a physician, nurse practitioner, or physician’s assistant—nurses owe a duty to patients to keep them safe by:
· Knowing why a medication is being prescribed for a patient.
· Knowing what a prescribed medication does.
· Performing and documenting an assessment before giving the medication.
· Performing and documenting a reassessment after giving the medication.
· Promptly reporting any problems that the patient experiences to the prescribing provider.
Sometimes busy nurses don’t provide the care that the law and standard of care requires. I’ve had many conversations with clients who have explained that nurses came in and out of the room quickly without doing any real assessment. Clients have also told me that nurses sometimes weren’t helpful in getting physician attention when it was urgently needed.
We are here to help
If you or a loved one has been seriously injured because of poor surgical, medical, or hospital care, then the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.
All consultations are free, and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.
Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.v