Leadership in Nursing
Medication Error Paper
Herve Etienne
Keiser University

The prevention of illness and injury combined with the diagnosis and treatment of the human response is the embodiment of what nurses do and who nurses are as healthcare professionals. Along with this gift they have to touch the lives of those within their communities comes a great responsibility, which includes providing physiological and emotional support for the patient. In terms of physiological and emotionally support one might question if one out weights the other and if it did which would you choose? Unfortunately in late august 2004 Nurse Wilcox chose put her efforts solely on the psychological state of her patient and she failed to follow a standing order to provide an prophylactic antibiotic, which resulted in the subsequent infection and death of her patient Mindi Tucker following a routine caesarian section. On the day of the incident the patient had complications from a Streptococcus-A infection, which developed from a caesarian delivery of her child at Baptist Hospital East in Louisville, Kentucky. The claim of medical malpractice in this case revolved around the fact that the antibiotic Cefotan was not given during the delivery as a prophylactic and may have prevented the infection from occurring. The hospital had this initiative in place as a standing order for caesarian deliveries and raised the question as to why it was not given, who was supposed to administer the drug, or if it would have even changed the outcome. This case explores those questions in detail to explain how this incident took place and why I believe the nurse might have made fatal error that could have been avoided.
Janet Wilcox, an experienced charge nurse of over 25 years, has had an extensive background in labor and deliver and was attending what she described as one of the most distressed patients she has ever seen throughout he career. Mindi Tucker, pregnant with her third child, was in a state of extreme panic during her delivery for reasons that were not disclosed during the case. The patient was admitted documented rash and labor contractions earlier that day. The prosecution argued that the failure to give the Cefotan caused the development of an aggressive infection Streptococcus-A. Strep-A, which is a group B beta hemolytic species found in raw milk, is a leading cause of bacterial sepsis and meningitis in newborns and major cause of endometritis and fever in post partum women. Infected postpartum women develop late onset symptoms several days or several months after giving birth. Symptoms include sepsis meningitis, seizures and psychomotor retardation. Neonatal infection may be prevented by detecting colonization by these bacteria in pregnant women and by administering antibiotics prior to birth (Tucker v. Women Care Physicians of Louisville, 2012). One of the most common antibiotics used by the hospital in particular was Cefotan. Cefotan is a semisynthetic beta-lactam antibiotic, classified as a third-generation cephalosporin and is generally less active against susceptible Staphylococci than first generation cephalosporins are but has a broad spectrum of activity against gram-negative bacteria when compared to first and second generation cephalosporins (Venes, 2013). For the obstetricians of Baptist hospital east the use of this specific antibiotic was part of a standing order “order 11”. A standing order is a written document about policies, regulations, or orders regarding patient care and gives nurses the authority to carry out specific actions under certain circumstances, often when a primary care provider is not immediately available (Berman & Snyder, 2012).
More than almost decade before Mindi Tucker was admitted Baptist hospital east, the hospital’s patient care committee agreed upon the provisions of this standing order which requires all C-sections have 2 grams of Cefotan prepared for infusion at time of clamping.