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Amber Mitchell

on 6 November 2013

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The Case of the Dennis Quaid's twins

Judicial Process
The series of steps in the course of the administration of justice through the established system of courts” (Merriam-Webster, 2013, para. 1).

The case of Dennis Quaid’s twins Zoe Grace and Thomas Boone was settled with Cedars-Sinai Medical Center for $750,000 for mistakenly administering a heparin flush of 10,000 units/ml versus the ordered dose of 10 units/ml. '

The Quaid’s brought suit against Illinois based Baxter Healthcare who manufactures the heparin used in the twins medication error on grounds of negligence.

The negligence suit included that Baxter Healthcare a) failed to recall the 10,000 unit vials after having knowledge of previous infant deaths, b) failed to repackage the 10,000 unit vials, c) negligent in designing, marketing, and selling the 1ml vials of heparin all in the same colors when they knew this could have caused a fatal error, d) failed to issue an urgent warning to all the healthcare providers that had purchased this product so that proper measures could be implemented, and e) failed to provide an adequate after market solution to the existing easily confused vials (Turkewitz, 2013).

The case was dropped due to jurisdiction because the medication error occurred in California and not in Illinois where Baxter Healthcare is located.
Healthcare Laws
Health care laws are implemented to protect individuals from various health related issues.
There are ‘five rights’ of medication administration: right patient, right medication, right dose, right route, and right time. Deviation in any one of these which results in harm or death can lead to a malpractice suit.
The nurses who subsequently administered adult-dose heparin to the infants violated hospital policy and legally could have been held liable for malpractice by failing to verify that it was the correct dose prior to flushing the infants’ I.V. site. This would have been considered failure to follow standard of care.
Cedars-Sinai did not immediately notify Dennis and Kimberly Quaid regarding their twin’s medication error until the following morning, which falls under failing to disclose a medical error. However, after the hospital did notify the Quaid's Cedars-Sinai also issued an apology and $750,000 settlement.

Professional standard of practice
The American Nurses association(AMA) House of delegate and the ANA board of directors sets policies for nursing practice.

A revises standard of practice was revised in summer of 2010

The revised policy contains 2,800 pages of the nursing scope and standard of practice

The policy outline the scope, responsible core values technology and innovation, and competency for nurses

Following this incident Baxter, relabeled/color coded the heparin vials. As part of the settlement, Cedars spent millions – on electronic record keeping, bedside bar coding, computerized physician-order entry systems-to improve patient safety. In 2008, the Quaids formed the Quaid Foundation which called for hospitals to adopt bedside bar coding, scans on patient’s wristbands to match scans on medications and other improvements so that the wrong medication does not go to the wrong patient. Since that time, Quaid has teamed with Charles Denham, M.D., a leader in the patient safety movement who founded a nonprofit Texas institute called Texas Medical Institute of Technology (TMIT) which test systems and promotes healthcare safety
“Medication errors remain the most common source of liability for
nurses in all practice settings, and medication errors continue to be the
number one cause of mortality and morbidity in hospitalized patients”
(Guido, 2010, p. 422). According to the Institute of Medicine, “an
estimated 1.5 million people in the United States are victims of
medication errors each year, resulting in upward of $3.5 billion in extra
medical costs” (2006, para. 1).

Disciplinary Actions
More and more nurses are being named defendants in malpractice lawsuits, according to the National Practitioner Data Bank (NPDB).
The trend of actions and issues that prompted charges of negligence that led to malpractice lawsuits against nurses shows no signs of stopping, despite efforts by nursing educators to inform nurses and student nurses of their legal and professional responsibilities and limitations.
From 1998 to 2001, for instance, the number of malpractice payments made by nurses has increased.
A charge of negligence against a nurse can arise from almost any action or failure to act that results in patient injury-most often, an unintentional failure to adhere to a standard of clinical practice-and may lead to a malpractice lawsuit.

Quaid’s newborn admitted to cedar Sinai ICU
Following heparin injection.
Mix up of heparin vials by nurses at Cedar’s hospital.
Infant dose of heparin consist of 10 units, compare to adult dose of 10,000 units
Law suit was filled in Los Angeles Superior courts following incident.
Cedar Sinai was named in the Law suit.

Ethical Issues
Fidelity : is keeping one’s promises or commitments
As nurses, we have a commitment to patients and families to deliver safe and excellent care
The nurse is accountable for every action she made while taking care of the twins
By not properly checking the medication dose, the nurse did not keep her commitment to practice safely
By lying on the phone that everything was okay with their twins the night of the incident, the staff was dishonest

Ethical Issues
As a nurses, we must practice within the boundaries of competence.
Non Maleficence: states that one should do no harm, including the inflicting of pain and suffering an others.

While unintentional, the nurse could have caused serious harm by not taking the time to properly double check the heparin medication to ensure it was the proper dosage

Approrpiate Documentation
Document all information thoroughly, including what was done and what was observed.
Make an entry for every observation
Nurse must record clearly, legibly, and accurately, and use appropriate terminology.
File event report for quality purposes, but do not mentioned it in official documentation in patient’s chart
Description of twins reactions to treatments, procedure, medications, and teaching
Record action taken and person contacted soon after overdose of heparin. Include specific names
Notes made at the time of or immediately following the event record, with correct time and date

Amber Mitchell
Nicole Coye
Sharon Palmer
Theresa Dempreh
Rani James
Nursing 478

Defines Scope of Practice

Laws that represents and regulate a nurse's scope of practice in the state a licensed nurse works.

These laws protect patients from harm as well as lay the rules and regulations for the specific level of a nurse's educational and licensure requirements.

Each state establishes its own Nurses Practice act

Individual Professional Responsibility

Establishes disciplinary procedures

Nursing Practice Acts
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