Safety, Ethics, and Legal Practice

At 1730 on a medical unit, an RN is about to give an ordered pre-meal dose of rapid-acting insulin by pen to a 72-year-old man whose pre-meal capillary glucose is 7.2 mmol/L and whose blood pressure is 128/76 mmHg. The prepared pen is labelled with the name of the client in the next bed, and the man in front of her says he is "usually given a different pen." The RN stops before administering. The decision is how to protect both clients now and what to do with the event afterwards: identity check, notification, documentation and a report, even though no insulin was given. Clinical priority: confirm the right client and order with two person-specific identifiers before any medication is given, then report the near miss so the system can be fixed. Learning objectives. By the end of this lesson you will be able to: 1. Use a just-culture lens to separate human error, at-risk behaviour and reckless conduct. 2. Apply autonomy, beneficence, non-maleficence and justice to a bedside decision, including a capable client's refusal. 3. Judge whether consent is...