Legal Eagle Eye Newsletter for the Nursing Profession(4)4 Jan 96


   Quick Summary: The patient went into a prolonged bout of seizure activity in the intensive care unit following coronary artery bypass surgery.   It left him with serious, permanent brain damage.

   In the court suit which resulted, there were complex allegations of medical and nursing malpractice.

   In making its ruling, the Appellate Court of Illinois appears to have faulted the nurses in two respects for their care of this patient:

   1. The court ruled that nurses have the legal duty to assess the patient’s condition, and to notify the physician of any major developments. This includes the duty to recognize when a patient is having a seizure, the duty to appreciate the gravity of seizure activity, especially if a seizure progresses to status epilepticus.

   2. The court also ruled that nurses have the legal duty to interpret physicians’ medication orders in a fashion consistent with the proper medical management of the patient’s condition. In this case a nurse interpreted an order for phenobarbital to mean that a loading dose of 200mg should be given at once, then 200mg more at the end of four hours if the patient had seized during that time. It was below the standard of care for ICU nursing to have interpreted an order that way, given that the medication has no effect unless it is given prophylactically or right when seizure activity starts, and cannot reverse the effects of seizure after the patient has been in seizure for an extended period of time. Glassman vs. St. Joseph Hospital, 651 N.E. 2d 1186 (Ill. App., 1994).