A doctor’s order is only as good as the nurse who carries it out.
The antibiotics are due every six hours, the vital signs to be checked every 15 minutes after surgery, the blood draw ordered before morning: Each one is just a line in a chart until somebody at the bedside makes it happen. When nursing staff misses a doctor’s orders, the patient usually doesn’t find out until something has gone wrong.
And then the family is left wondering whether this was bad luck or a preventable mistake.
In Kentucky, that difference can be the basis of a Louisville medical malpractice claim. Here’s what the law expects of nurses, why orders get missed, what a missed order costs the patient, and how to tell if it happened to you.
Following Orders Is Only Half a Nurse’s Job
The standard of care for nurses asks a simple question. What would a reasonably careful nurse with the same training have done in the same situation?
When the chart says to give a medication at 2 p.m., and nobody gives it, the answer is easy. A failure to follow physician orders, without a sound clinical reason and a call to the doctor, is a textbook breach of nursing duty.
Kentucky expects more than obedience, though. The Kentucky Board of Nursing holds nurses accountable for their own decisions, which means a nurse who believes an order is wrong is accountable for that decision. This means a nurse who believes an order is wrong has a duty to question it and hold off until the prescriber confirms it.
So, nursing negligence in Kentucky runs in two directions. A nurse can fall short by skipping a good order or by carrying out a bad one without checking it.
Who pays? Usually the hospital. Nurses are typically hospital employees, and an employer generally answers for the negligence of its staff on the job.
Why Orders Get Missed
It’s rarely just one careless nurse.
Most missed orders trace back to the system the nurse works in. Federal patient safety researchers have a name for the problem: missed nursing care, and in the studies they reviewed, between 55 and 98 percent of nurses reported missing at least one item of required care during the period studied.
The causes will sound familiar to anyone who has spent a night in a hospital. They include:
- A nurse covering too many patients at the end of a long shift
- A hospital communication breakdown at shift change, when the order the day nurse knew about never reaches the night nurse
- An electronic chart that buries a new order under a dozen routine alerts
- Monitors that beep so often the staff stops hearing them
That last one is noteworthy. One study counted 187 alerts per patient per day in a single intensive care unit.
The nurse in this story is usually overworked, which is not at all the same as being careless. Thin staffing and broken handoffs are choices a hospital makes, and in a nursing malpractice claim they usually end up as the patient’s evidence.
What a Missed Order Costs the Patient
Orders exist because timing matters.
An antibiotic that arrives hours late gives an infection a head start to spread, and an infection that spreads can become sepsis. Vital signs that go unchecked after surgery let internal bleeding or slowed breathing continue until someone happens to look.
A skipped blood thinner can mean a clot. A patient who isn’t turned on schedule develops pressure sores. Medication administration errors alone are common.
In studies where observers watched hospital staff give drugs, median error rates ran from 8 to 25 percent. The law calls the result damages. In Kentucky, medical malpractice damages can include the cost of the extra treatment, lost income, pain and suffering, and, in the worst cases, a family’s losses after a death.
One hurdle stands in front of all of it. You have to show that the missed order caused the harm, not the illness that put you in the hospital in the first place.
That almost always requires a medical expert to review the chart.
How to Tell If It Happened to You
Hospitals rarely just come out and announce a missed order.
Watch for a patient who was stable and then declined fast. Watch for a burst of new tests and new faces after a quiet night. Watch for explanations that change depending on who you ask. And trust what you saw yourself: the dose that came late, the call light nobody answered, the monitor nobody checked.
Then ask for the medical record, which you have the legal right to see.
Ask specifically for the medication administration record, the nursing notes and the vital-sign flow sheets, because those pages show what was ordered, when it was due and whether it was done. Blank stretches and late entries are always worth a closer look too.
Write down names, dates, and times while you still remember them. And don’t wait.
Kentucky generally gives patients just one year from the time they discovered the injury or should have.
McCoy & Hiestand, PLC Can Find Out What Happened at the Bedside
An order that never reached the bedside leaves a trail, but you shouldn’t have to be the one to follow it while you or someone you love is in recovery.
At McCoy & Hiestand, PLC, our firm’s attorneys bring 58 years of combined experience handling medical negligence cases, and we know how to read a chart for what it says and for what it leaves out. We work with medical experts, deal with the hospital and its insurer, and watch the one-year deadline so you don’t have to.
If you’re searching for a Louisville medical error lawyer, call our Louisville or Bardstown office for a free consultation.
You deserve a straight answer about what happened.
