Labor And Delivery: Giving And Charting Of Narcotics By Nurse Complied With Standard Of Care
Legal Eagle Eye Newsletter for the Nursing Profession
September 1995
Quick Summary: The baby was born with low Apgar scores, allegedly due to respiratory distress from Demerol the L&D nurse gave the mother. The nurse was criticized in the suit for an alleged failure to communicate to the staff of the neonatal nursery that she had given the mother IV Demerol during labor.
The court ruled that the labor-and- delivery chart "spoke for itself" to the medical and nursing staff in the nursery. There was no additional legal duty for the nurse to verbally inform the nursery of the drugs administered during labor, apart from the proper notations the nurse had recorded in the labor-and-delivery chart.
There was a physician’s order in the patient’s labor-and-delivery chart for p.r.n. Demerol for pain. According to the ruling of the Appellate Court of Illinois, a p.r.n. order amounts to a delegation of authority by the physician to the nurse to administer the drug when the nurse deems it necessary. The nurse may administer a p.r.n. medication without first consulting with the physician.
In this case, the court accepted the testimony of two expert witnesses, physicians who testified that the labor-and-delivery nurse had complied with the standard of care. She followed the physician’s orders and accepted nursing practice, by administering the drug, a pre-measured, single 25mg syringe, given IV over the course of one minute, because the patient complained of extreme pain and was not making progress in her delivery. The order was for only one p.r.n. dose, without re-contacting the physician. The nurse gave only one dose.
The nurse then properly charted that the drug had been given, and the time, dose, route and reason for giving it.
Chiricosta vs. Withrop-Breon et al., 635 N.E. 2d 1019 (Ill. App., 1994).