Objectives: a) Define role nurse and medication in patient care b) To collect maximum information on laws concern to administration of medication by nurse. c) Acquire skills of preparing project on given topic as partial fulfillment of said course. d) Read the cases related to concern topic

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Project work
Topic: Laws concernto administration of Medicationby Nurse
Student: Mr. Sunil M Kulkarni.
Certificate Course in Law and Medicine.
BV, New Law College, Sangli.
Guide: Dr. Vinod Pawer. B.A.M.S., L.L.M .NET
Course co-ordinator, BV,New Law College , Sangli.

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To
Dr.(Mrs)Pooja Narwadkar
The Principal
Bharati Vidaypeeth’s
New Law College, Sangli.
Title of project
“Laws Concern to Administration of Medication by Nurse”
Submitted by
Mr.Sunil Malhar Kulkarni,
Student of
Certificate Course in Law and Medicine
Bharati Vidyapeeth’s New Law College , Sangli and
The Director,
Department of Adult and Continuing Education and
Extension Work,
Shiviji University, Kolhapur.
This project is submitted for the partial fulfillment of the
Certificate Course in Law and Medicine
Year 2015-2016”

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Bharati Vidaypeeth’s
New Law College, Sangli.
Certificate of approval of project work
This is to certify that Mr.Sunil Malhar Kulkarni, Student
of Certificate Course in Law and Medicine has original
and satisfactorily completed the project work entitled
“Laws Concern to Administration of Medication by Nurse”
Dr. (Mrs) Narwadkar,
The Principal,
Bharati Vidyapeeth’s New Law College , Sangli
and
Dr.Vinod Pawar.
B.A.M.S. , L.L.M. , NET,
The Guide,
Bharati Vidyapeeth’s New Law College , Sangli

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Index
Sr.No Topic Pg.No.
Title and certificate of project 1-3
Index 4
Acknowledgement 6
Introduction 8
Need for project 12
Previous events related to topic 18
Data collection, analysis, results and references to results 24-26
Graphical presentation of result 26
Summary 27
Conclusion 27
Recommendations 27
References 28-29

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Title of project:
Laws Concern to Administration of Medication by Nurse”
Aim:
To acquire comprehensive knowledge and skills of doing project on laws concern to
administration of medication by nurse.
Objectives:
a) Define role nurse and medication in patient care
b) To collect maximum information on laws concern to administration of
medication by nurse.
c) Acquire skills of preparing project on given topic as partial fulfillment of said
course.
d) Read the cases related to concern topic

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Acknowledgement
‘To dear GOD whose eternal blessings and divine presence helped me
fulfill all my goals’. First of all, I am very much thankful and grateful to ALMIGHTY
GOD, whose blessing, inspired and encouraged me to complete the project
I am deeply expressing my sense of gratitude our Hon. Dr. Patandrao
Kadam, Chancellor, Hon. Dr. Prof. Shivajiro Kadam Vice-Chancellor Sir, and Hon. Dr.
Vishwajeet Kadam , Sercretory, BVDU,Pune for their all type of support for academic
activities.
I express my sincere gratitude to Dr.Pooja Narwadkar principal, Bharati
Vidyapeeth’s New Law College ,Sangli for the support, encouragement and valuable
suggestions throughout the period of study.
An effort of this academic pursuit would not have been a reality for me,
but for the constructive and purposeful support, guidance and encouragement rendered by
our teacher Dr. Vinod Pawer sir. I fall very short in words to say thanks. Please accept
my feeling and gratitude towards you.
I am also indebted to Dr. (Mrs.) Nilimal R Bhore, Principal,BVDU, college
of nursing for finding enough time for me to render administrative support, help and
encouragement for the study.
I express my sincere gratitude to the Librarians New Law College, Sangli,
College of Nursing, Sangli and Medical College and Hospital ,Sangli for provided
literatures for my study.

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I am very much thankful to Mr. Sachin Kale, Shivraj DTP, Centre for their
good and timely work.
And last but not the least, I also express my sincere and humble gratitude
towards BVDU, MCH, Sangli nursing staff to participated in the project. Without them I
could not have completed this study.
I am also thankful to all my, colleagues, family members, friends and
well-wishers who helped me all along.
Mr.Sunil M Kulkarni

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Introduction
Nursing, as an integral part of the health care system, encompasses the promotion
of health, prevention of illness, and care of physically ill, mentally ill, and disabled
people of all ages, in all health care and other community settings. Within this broad
spectrum of health care, the phenomena of particular concern to nurses are individual,
family, and group "responses to actual or potential health problems"(International
Council for Nurses.)
The nurse is a person who has completed a program of basic, generalized nursing
education and is authorized by the appropriate regulatory authority to practice nursing in
his/her country. Basic nursing education is a formally recognized program of study
providing a broad and sound foundation in the behavioral, life, and nursing sciences for
the general practice of nursing, for a leadership role, and for post-basic education for
specialty or advanced nursing practice.
The nurse is prepared and authorized (1) to engage in the general scope of nursing
practice, including the promotion of health, prevention of illness, and care of physically
ill, mentally ill, and disabled people of all ages and in all health care and other
community settings with ethical, professional and legal constraints; (2) to carry out health
care teaching; (3) to participate fully as a member of the health care team as medication
provider, assist in diagnosis and other treatment modalities; (4) to supervise and train
nursing and health care auxiliaries; and (5) to be involved in research. (6) Keep record of
all nursing activities. (ICN, 1987)
What Is Medication Administration? Medications need to be safe and effective. Doctors,
nurses, nurse practitioners and a few other professionals are trained in how to safely give
you medication. Administration of medications requires understanding how the
medication is entering your body. It also requires knowledge of when the medication

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needs to be administered, possible side effects, and toxicity. Training for professionals
also includes proper storage, handling, and disposal of medications.
Route of Medication Administration
Medication can be given many different ways. Mostly they are given through body
openings .Some examples include oral, nasal ocular, anal, urethral and skin in muscle,
vein or body cavities.
What are the types of medication benefits? Most patients like you hope their medications
will provide symptom relief, reduce the risk of complications from their medical
condition, and/or improve their survival chances. Improvements in laboratory test
measurements typically are not as important to patients, unless they reflect better control
or prevention of their underlying condition. From the patient’s point of view, there are
three main reasons to take a medication: to feel better, to reduce the risk of future disease
complications, and to live longer
Dose and Time of Medication Administration. Any prescription or instructions
state how often and how much of a medication should be given. Calculating the correct
dosage for some medications can be very precise, and should only be done by
professionals. Only that dose stated in the prescription or instructions should be
taken. Timing is also important in medication administration. Some medications need to
reach a consistent level in your bloodstream in order to be effective.

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Standards for the Administration of Medicines These are designed to be generic
standards. Training and education requirements The person who is administering the
medicine or delegating responsibility for administration of the medicine will be satisfied
that they: > understand their scope of practice as determined by the appropriate
regulatory authority or understand their role and responsibilities as per their job
description in the case of health care assistants. If delegating the regulated nurse or
midwife should be satisfied that the individual to whom they are delegating the activity of
administering medicines has an appropriate level of education and training and has been
assessed as competent.. The registrant is accountable for their actions including
delegation; has had adequate training/orientation for the type of medicine being
administered; is familiar with local area policy and guidelines related to medicine
administration; and understands the relevant professional and legal issues regarding
medicine administration. Prior to administration Prior to administration of medication,
the regulated nurse or midwife administering the medicine: within the limits of the
available information, confirms the correctness of the prescription/medication chart, and
the information provided on the relevant containers; ensures that they are aware of the
client‘s current assessment and planned programme of care; and makes a clinical
assessment of the suitability of administration at the scheduled time of administration;
ensures that appropriate protocols regarding the preparation, administration and
documentation of controlled drugs are followed (all controlled drugs must be stored in a
locked cabinet); checks the five rights + three: the right medicine in the right dose must
be administered to the right person at the right time by the right route. The nurse is
certain the patient is showing the right indications and completes the right documentation
prior to and post administration. The nurse is aware that the person has the right to refuse
the medication; checks the expiry date of the medicine; checks that the client is not
allergic to the medicine; in the case of children and where the dosage of medication is
related to weight or surface area (for example cytotoxics) or where clinical condition
dictates, ensures the correct weight has been recorded in kilograms only and that the
medicine to be administered has been prescribed in accordance with the correct weight;
The Guidelines for Nurses on the Administration of Medicines is aware of the
therapeutic uses of the medicine to be administered, its normal dosage, side effects,

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precautions and contra-indications; contacts the prescriber/pharmacists, designated senior
health professional as appropriate, if: the prescription/medication chart or container
information is illegible, unclear, ambiguous or incomplete; it is believed that the dosage
or route of administration falls outside the product license for the particular substance;
there are potential adverse interactions with other medicines where contra-indications to
the administration of any prescribed medicine are observed; prepares the medicine as
specified by manufacturer/area policy and protocols; when believed necessary, refuses to
administer the prescribed substance. If this situation arises, document clearly the reason
and inform the prescriber/medical staff; pays due regard to the environment in which that
care is being given e.g. appropriate cardiac monitoring is available; is certain of the
identity of the client to whom the medicine is to be given; informs the client of the
purpose of the medicine as appropriate, and provides access to relevant client information
leaflets; and if checking the calculations and preparation of a medicine undertaken by a
colleague, is certain that the calculations and preparation undertaken by the colleague are
accurate.
It recommends the nurse checking the calculations and preparation repeats the
calculations independently of the colleague. During administration During the
administration of medication, the regulated nurse administering the medicine: monitors
the patient for adverse effects of the medicine and takes appropriate action as determined
by local guidelines e.g. anaphylaxis management; and uses the opportunity, when
appropriate, for emphasizing to the client and significant others about: the importance
and implications of the prescribed treatment; and enhancing their understanding of its
effects and side-effects After administration After administration, the regulated nurse
administering the medicine: makes clear and accurate recordings of the administration of
each individual medicine administered or deliberately withheld, or refused, ensuring that
any written entries and the signature are clear and legible. Documentation must be timely;
records the positive and negative effects of the medicine and makes them known to the
authorized prescriber; and ensures the record is completed when the task of administering
medication has been delegated.

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Need for the project
There are many medication errors or malpractices observed. They are dangerous
for patient, nurse and entire society. It concern with professional, legal and ethical
problems. The loss may be irreversible, costly even death.
Definition: According to the National Coordinating Council for Medical Error
Reporting and Prevention, a medication error is defined as "any preventable event that
may cause or lead to inappropriate medication use or patient harm while the medication is
in the control of the health care professional, patient, or consumer." (CDER, 2001)
Causes: Slips and lapses were the most commonly reported unsafe acts,
followed by knowledge-based mistakes and deliberate violations. Error-provoking
conditions influencing administration errors included inadequate written
communication (prescriptions, documentation, transcription), problems with medicines
supply and storage (pharmacy dispensing errors and ward stock management), high
perceived workload, problems with ward-based equipment (access, functionality),
patient factors (availability, acuity), staff health status (fatigue, stress) and
interruptions/distractions during drug administration. Few studies sought to determine
the causes of intravenous MAEs. A number of latent pathway conditions were less well
explored, including local working culture and high-level managerial decisions. Causes
were often described superficially; this may be related to the use of quantitative surveys
and observation methods in many studies, limited use of established error causation
frameworks to analyse data and a predominant focus on issues other than the causes of
MAEs among studies.
Importance : Medication errors have become of increasing concern in the last
few years. Due to medication errors, patients have had increased length of stays in
hospitals. An increase in hospital length of stays leads to an increase of healthcare
dollars spent. These types of errors put a financial strain on an already tight healthcare

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budget. Medication errors not only lead to increased costs, but they can also lead to
prolonged suffering of patients, and even death.
Types of Medication Errors : There are many types of medication
errors. Medication errors may be caused by pharmaceutical companies, pharmacists,
physicians, nurses, patients, and any other personnel involved with the handling,
preparation, or administration of medications. The most-common errors are listed
below. Missed or forgotten doses ,Use of wrong technique for drug administration
,Illegible medication orders ,Duplicate therapy (giving medications not knowing a dose
was given) ,Antagonistic effects of drugs (drug-drug interactions) ,Equipment failure
(infusing pumps malfunction) ,Inadequate monitoring for side-effects ,Medication
preparation error
Results of Medication Errors :
There are many different results from medication errors occurring.
Prolonged Suffering for Patients
Patients can become more sickly as a result of incorrect medication
administration. Luckily, some medication errors are such that a patient will not be
harmed. However, the majority of medication errors have nugatory effects.
Increased Healthcare Costs
When patients are adversely affected by medication errors, they can become sicker and
have an increased length of stay in the hospital. This causes hospitals and insurance
companies to loose money. With the healthcare budget seriously lacking, correction of
these errors could save millions of dollars.
Death

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The worst results of medication errors are death of the patients. It is sad because their
deaths are unnecessary. If proper precautions are taken, mortality rates from medication
errors can decrease.
Malpractice Suits
When medication errors occur and negatively affect patients, healthcare employees can
be faced with legal action.
Malpractice is defined as " Failure of a person with professional education and skills to
act in a reasonable and prudent manner." (Yoder-Wise, 1999).
In today's healthcare environment, it is important for employees, especially nurses, to
be aware of legal issues concerning them. Ways to Reduce Medication Errors
Just as there are many medication errors, there are many ways to help reduce the
amounts of errors. They are listed below.
 Physician Order Entry (POE) : By having physicians enter medication orders
into computers, risk of medication errors associated with illegible handwriting can
be abolished.
 Monitor Patients Better : Increasing staffing can help give nurses more time
to monitor patients and the ability to detect slight changes in condition that could
be due to medication errors.
 Eliminate Fear From Reporting Medication Errors : Many healthcare
employees shy away from reporting medication errors for fear of repercussions
from the administration. Changing the way medication errors are reported can
help more errors to be reported and increase the ability to evaluate and change
WHY medication errors are occurring.

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 Have Pharmacists Make Medical Rounds With Doctors : If pharmacists could
make medical rounds with doctors, surely some medication errors could be caught
before they are written orders.
 FDA MEDWATCH SYSTEM
The FDA MEDWATCH SYSTEM is an online way of reporting medication errors
or adverse events caused by medications. The Center for Drug Evaluation and Research,
CDER, a division of the FDA, compiles medication errors and submits bulletins to the
healthcare community alerting them to special warnings. To see how to report a
medication event, visithttp://www.fda.gov/medwatch/how.htm
 Perform The "5 RIGHTS" Of Medication Administration
Anyone administering medication should perform the "5 rights" before
administering the medication. The "5 Rights" are: 1) Giving the right medication , 2)
Giving it to the right patient , 3) Giving the right dose ,4) Giving via the right
administration route , 5) Giving it at the right time. Other ways for nurses to prevent
medication errors are:
1) research drug if you are unfamiliar with it , 2) clarify orders if
you cannot read them ,3) document timely and properly , 4) if you are unsure of anything
ASK!!!
Remember: A little extra time can help save money and lives when it comes to
proper medication administration!!!!

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There are no special laws for nursing. The Indian Nursing Council, Maharashtra
Nursing Council and laws of state government are applied in administration of
medication. They are Consumer protection act 1986 ,Indian evidence act ,Laws of
privileged communication Laws of torts , misuse of drug act, possession of illegal drugs,
sedative and narcotic drugs use act and Indian Penal Court.

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Historical perspectives concernto laws and administration of
medication
Events related to the above topic in Indian scenario is negligible but in foreign
countries it is highlighted.Surely tomorrow it will come here and will show its impact.
Knowing and prevention of it is better t han cure. Few events are mention here to
support for selection
Patient intubated pulls out tube and suffers subsequently cardiac arrest: In
Bhajanlal Gupta & Another V.Mool Chand Kharati Ram Hopital & Others49, the
complainant’s son was admitted in OP-hospital for treatment of his back lower and upper
limbs. He had been put on oxygen and being monitored in ICCU, yet there were two very
serious lapses, one of the nurses not noticing that the oxygen tube had come out and the
other of delay of about two hours in intubating the patient.
There was also a further lapse on the part of the nurse not being vigilant to ensure that the
oxygen tube remained in place and if at all it is pulled out by the patient it was restored
immediately. The court held that there was negligence on the part of doctors in treating
the deceased patient because something which is required to be done was not done. It is
also a settled principle which states that a specialist is required to know the latest
techniques for management of the patient and if he is ignorant about it, then he could be
considered to be negligent in following his profession50. 47 Ibid page 306 at Para 27.48
Navya S. and Others V. Manipal Northeside Hospital & Others 2006(II) CPJ 48.
Child suffers brain damage following injection given by nurse on advice of the
senior consultant paediatrician-Negligence per se: In the case of Spring Meadows
Hospital & Another V. Harjot Ahluwalia. (Through K.S. Ahluwalia) and Another133 the
appeal preferred against the decision of the National Commission which granted the
compensation to the complainants–respondents. The Supreme Court held that a
consultant could be negligent where he delegates the responsibilities to his junior with the
knowledge that the junior was incapable of performing his duties properly. An error of
judgment could be negligence if it is an error which would not have been committed by a
reasonably competent professional man acting with ordinary care. Both the nurse and

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resident doctor were negligent for which the Insurance Company was liable to indemnify
the child and its parents.
By this observation, the court makes it clear that the hospital can be held
negligence where it employs any unqualified persons as nurse or para medical staff and
similarly, where the doctor entrust his duty with the knowledge that his subordinates
cannot perform so delegated work effectively. The court concurred with the National
Commission which found that there had been considerable delay in reviving the heart of
the child and this delay damaged the brain of the child. Here, the question is whether the
court acted upon independent judgment of its own or merely upheld the expert testimony
who opined there was delay in reviving the heart of the child. Although the judicial rule
of prudence requires the court to decide and the expert, the Supreme Court has simply
concurred with the expert opinions
The family of a 79-year-old dialysis patient is suing a Florida nurse who
accidentally gave him a deadly dose of a drug that induces paralysis, instead of an
antacid. "The hospital killed my dad," said Marc Smith of Miami, Fla., whose father went
into cardiac arrest after the nurse's mistake at North Shore Medical Center in
Miami.Richard Smith, who had a history of kidney disease, had been admitted to the ICU
after a dialysis session where he experienced severe shortness of breath. The next day,
July 30, 2010, he complained of an upset stomach, so the doctor prescribed the
antacid.Marc Smith came by to visit that morning, and found his dad "unconscious,
unresponsive and on a respirator.""The nurse said my dad had coded. I said, 'He coded?
When did that happen?'"Smith looked at his dad's chart, and found his father had been
resuscitated about 10 minutes earlier."The nurse basically told me, 'Talk to the doctor,"
Marc Smith said.When he did, he says, the doctor told him, "I'm sorry to have to tell you
this but the nurse administered the wrong medication and sent your dad into respiratory
arrest." "He said the packaging looked the same and he grabbed the wrong package,"
Marc Smith recalled.
Uvo Ologboride, the nurse named in the lawsuit, had given Smith pancuronium.
The drug, which is typically used during intubations, acts as a muscle relaxant and
paralytic. In higher doses, pancuronium is used to administer lethal injections. Thirty

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minutes later, Smith was found unresponsive. Although doctors were able to revive
Richard Smith, he was brain dead. Ever since Marc Smith was a boy, "My mother and
father had taken in a countless number of children who were in bad situations at home or
didn't have place to stay," he said. "They did it on a teacher's salary, but we never wanted
for anything growing up."
A report from the Florida Agency for Health Care Administration demonstrated
that with all the safeguards in place to prevent a patient from receiving the wrong
medication, the nurse would have had to ignore nearly all of the protocol in place for
administering drugs.Specifically, the nurse "failed to look and read what medication he
was taking … failed to scan to determine the right count for the medication, failed to
match the patient's ID with the scanned medication."
In addition, the report says, the pharmacy wasn't able to show any justification for storing
pancuronium in that particular area of the hospital. Medical Error: Richard Smith Dies
.After Receiving Wrong MedicationThe Smith family originally filed a wrongful death
lawsuit in February against the hospital's parent company and the pharmacist, but they
recently amended their complaint to include the nurse and the hospital. They now claim
the nurse not only administered the wrong medicine, but also failed to properly monitor
Richard Smith.
"We learned that the nurse who administered the medication had left the room for 30
minutes," Marc Smith said.
Nizam Institute‘s case (supra) in which this Court directed the Hospital to pay the
entire amount of compensation to the claimant in that case even though the treating
doctors were found to be responsible for the negligence. The claimant also relied upon
the observations made by this Court while remitting the case back to National
Commission for determining the quantum of
compensation, to emphasize upon the negligence on the part of the Hospital. The findings
of this Court in Malay Kumar Ganguly’s case read as under:“76. AMRI records
demonstrate how abysmal the nursing care was. We understand that there was no burn

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unit in AMRI and there was no burn unit at Breach Candy Hospital either. A patient of
TEN is kept in ICU.All emphasis has been laid on the fact that one room was virtually
made an ICU.Entry restrictions were strictly adhered to. Hygiene was ensured. But
constant nursing and supervision was required. In the name of preventing infection, it
cannot be accepted that the nurses would not keep a watch on the patient. They would
also not come to see the patients or administer drugs. The liability of compensation to be
apportioned by this Court on the appellant-AMRI
Bad nurse washed up - patient was fed detergent .3 years ago3 years ago march
19, 2013 10:03pm.
AN Indian nurse who fed an elderly patient dishwashing liquid instead of medication
could have been confused about what was in the bottle because of his bad English.
Bhavesh Shah was working at the Sydney Adventist Hospital at Wahroonga in May 2009
when he treated a 79-year-old patient who had come in for a hip replacement. Mr Shah
gave the patient, who cannot be named for legal reasons, some green liquid from a bottle
the man had brought in that was marked as containing heart pills. The then 28-year-old
had been working at the hospital for less than a month after finishing his nursing degree
at the University of Western Sydney, having previously studied biotechnology in his
native India. The patient thought he had been given a laxative, but soon complained to
Mr Shah that he felt unwell. He later told another nurse he was nauseous and had been
vomiting. Inquiries by hospital officials revealed the bottle's true contents - Morning
Fresh detergent - which the patient had used at home to clean his dentures. Mr Shah was
sacked the following month and the state's Nurses and Midwives Board ordered him to
complete a test to prove his English skills - but he failed in six attempts at a pass grade.
The state's Nursing and Midwifery Tribunal last week cancelled Mr Shah's registration
and banned him from practicing for at least a year. Mr Shah, who admitted giving the
man the liquid, claimed he followed four of the five "golden rules" of administering
medicine. But the tribunal said his behaviour was incompetent and either because of his
poor English or "reckless indifference" he did not read the label on the bottle, which
clearly referred to "capsules". "When he became aware of his error he failed to act
(showing) complete disregard for (the patient's) care and safety," the tribunal said.
Mr Shah will have to appear before the tribunal again before his registration is reinstated.

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Jane Toppan: the nurse who killed at least 31 patients with morphine. Jane
Toppan was an American nurse who killed thirty-one of her patients by administering
lethal injections of morphine. Over the course of two decades while working in the
Boston, as sachusetts area, Toppan may have actually killed upwards of seventy people
altogether. As a young, attractive twenty-six year-old nurse, Toppan was able to hide her
dark obsession with death from nearly everyone she worked with. Even as a nursing
student, she would alter her patients' medicine dosages to see what would happen to their
nervous systems, and once she became a Registered Nurse she took her skills to the next
level, administering overdoses of morphine and atropine. Toppan finally slipped up when
she murdered a man whom she was caring for as a private nurse. Along with Alden
Davis, Toppan also killed two of his daughters, leaving a third daughter to go to police
and start an investigation. Once one of the Davis girls was exhumed, authorities
discovered that she had been poisoned, and it didn't take much to figure out who was
behind the treachery. After Toppan was caught, she is quoted as saying that she wanted to
kill more people than anyone who has ever lived before. She confessed to thirty-one of
her murders, and provided details to solve them. Since Toppan had a well-documented
history of attempted suicide, she was committed to a mental hospital, where she lived for
forty years until her death in 1938.)
Dorothea Waddingham: the nurse who was hanged after killing a mother and
her daughter. Though Dorothea Waddingham was not a Registered Nurse, she ran a
nursing home near Nottingham, England for many years. Waddingham, who was a wife
and mother to five children, began taking elderly invalids into her home in the early
1930s. Two of these women were mother and daughter. First the mother died, and shortly
afterward the younger woman also passed away. It was then that their family discovered
that the younger woman had recently changed her will to leave everything to
Waddingham. She had also added some bizarre details, such as a desire to be cremated
immediately after her death, and she requested that her family not be notified when she
died.In order to have a cremation, two doctor's signatures were required to sign off on her
death certificate. The first doctor was well-known to Waddingham and signed off with no

23. 23
issues. The second doctor was suspicious, especially in light of the woman's recent
changes to her will. He ordered an autopsy of her body and found large amounts of
morphine in her system. After examining the deceased mother's remains, they found that
she had also died from a morphine overdose.Waddingham was found guilty of murder
and insurance fraud and was sentenced to death. As a young mother of five children, one
of whom was just three months old and still breastfeeding, the execution drew ten
thousand protesters who chanted, "Stop this mother murder!" Nevertheless, Waddingham
was hanged for her crimes in 1936.
Beverley Allitt: the nurse who injected children with air bubbles and
insulin.Beverley Allitt is a nurse who worked in the children's ward at Grantham and
Kesteven Hospital, Lincolnshire, England. During the course of fifty-nine horrible days
in 1991, Allitt murdered four children in the hospital by administering lethal doses of
insulin and injecting air bubbles into their blood streams. She also attempted to murder
three other children, and badly injured six more. Allitt was caught and sentenced to
thirteen life sentences for her crimes. Though we'll never know exactly why Allitt started
murdering her young patients in the hospital, in prison she was diagnosed with
Münchausen syndrome by proxy. This controversial psychological condition is described
as "involving a pattern of abuse in which a perpetrator ascribes to, or physically falsifies
illnesses in someone under their care to attract attention." Sentenced to only twenty-one
years in prison, which was the maximum sentence under Norwegian law at the time,
Nesset served just twelve of those years and is now free. He is thought to be living under
an assumed name

24. 24
Data collection, analysis and discussion.
Data collected on knowledge among staff nurses of Bharati Hospital, MC & H,Sangli
regarding laws concern to administration of medication by nurse. Self reported
questionnaire was given and response was colleted, analyzed and drawn results.
Knowledge among staff nurses of Bharati Hospital, MC & H,Sangli regarding laws
concern to administration of medication by nurse. n=20
Sr.
No
Questions Correct
Responses
(F)
%
1 Meaning administration of medication 15 75
2 5 Purposes of administration of medication 16 80
3 5 components of administration of medication 14 70
4 5 rights of administration of medication 13 65
5 5 causes of medication errors 10 50
6 5 systemic effects of medication error 8 40
7 5 most important points of care before ,during and
after administration of medication
11 55
8 5 points of safe administration of medication 17 85
9 5 laws concern to administration of medication 7 35
10 5 punishments for errors of administration of
medication
6 30
Total correct responses 117
Average correct responses 5.85=6

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A table showed that more than 50 % staffs have poor knowledge on item no 6,9,10.
These are less practical questions so the response was poor but they are important as a
professional nurse.
Few research studies related to law and medication administration.
Legal Awareness and Responsibilities of Nursing Staff in Administration of
Patient Care in A Trust Hospital Hemant Kumar, Gokhale, Kalpana Jain, and D.R.
Mathur
Introduction: The enactment of various legal provisions like Consumer Protection Act,
Right to Information Act and standardization of procedures and practices have brought
nursing care under legal ambit. Needless to say, the level of legal awareness amidst
nursing staff in India is abysmally low. Present study was undertaken to assess the level
of legal awareness and responsibilities of nursing staff in administration of patient care at
a trust hospital.Methods: An open ended questionnaire was prepared to assess the level
of legal awareness among the nursing staff. The GNM and ANM nursing staff deployed
at the nursing home and general wards only were randomly screened and specialty nurses
were exempted.Results: The knowledge on various legal provisions, as was applicable to
nursing, across all categories of nurses which were under review, was found to be poor.
The nursing staff had poor knowledge on patients’ rights and also on their legal
obligations towards patients. The GNM nurses fared better than ANM nurses. However,
46.67 % of nurses were found to be aware about cases of omission or
commission.Conclusion: This study substantiated the fact that nurses had poor
knowledge on the law that governed their profession and that in days to come, it would
become increasingly difficult for them to avoid law suits which were prepared against
them, unless remedial actions were taken.
Knowledge and Attitude of Nurses on Legal Aspects in Patient Care
Dr. Malarvizhi. S* and Dr.Rebecca Samson** A cross sectional study was conducted to
assess the knowledge and attitude of nurses on legal aspects in patient care. 510BSc and
Diploma nurses working in Pondicherry Institute of Medical Sciences Hospital (Private)
and Indira Gandhi Government General Hospital (Government) were selected by

26. 26
stratified random sampling technique. Questionnaire was used to collect information
regarding socio demographic variables and level of knowledge of legal aspects among
nurses. To measure the level of attitude, the semantic differential scale based upon a
seven-point rating scale was used. The results revealed that 44.5% (227) of nurses had
poor knowledge, 24.1% (123) of nurses had average knowledge, 21.2% (108) of nurses
had good knowledge, 8.6% (44) of nurses had very good knowledge and 1.6% (8) of
nurses had excellent knowledge. 65.5% (334) of nurses had highly favorable attitude and
34.5% (176) of nurses had moderately favorable attitude. The finding reveals that there
was a statistically significant weak positive correlation (r=0.18) between knowledge and
attitude among nurses (p<0.001) on legal aspects inpatient care management. The
findings shows that there was significant association between the nurses knowledge with
i) age, ii) educational status, iii) years of experience, iv)conferences/workshops attended,
v) organization vi) nursing colleagues faced legal problems, vii)legal problems faced by
self and viii)being oriented about legal aspects at p<0.05 level. There was significant
association between the nurses attitude with i) age, ii) organization and iii) oriented about
legal aspects at p<0.05 level.
Above information in bar graph:
0
2
4
6
8
10
12
14
16
18
1 2 3 4 5 6 7 8 9 10 11
Questions
Correct
response
Correct
responses
to each
by total
staff
Questions in serial number

27. 27
Summary of projectwork:
1. A table showed that more than 50 % staffs have poor knowledge on item no
6,9,10.
2. These are less practical questions so the response was poor but they are important
as a professional nurse.
3. Indian patients and nurses are still unaware about laws concern to administration
of medication
4. Good work of professional activities and interaction with legal bodies to expand
and extend the roles of professional nurse.
Conclusion:
Nurses need exposure to legal knowledge and impact of its on profession. National and
state nursing council must take efforts to update the legal knowledge to nursing staffs.
Present efforts like running of post graduate diploma in forensic nursing and nurse
fractioned is good sing of it
Recommendations:
1. Must have interdisciplinary courses like certificate course of medicine and law.
2. Renewal of registration on the basis of update knowledge of profession and its
use.
3. Must have a committee in every nursing school on professional conduct, code of
ethics and legal consultation.

28. 28
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1. Gowda N.Basic Principles and Practice of Nursing.Bangalore:
J.N.Publication;2010
2. Henry K. Foureur M. Medication Administration Error : Understanding the
Issues. Austrelian Journal of Advanced Nursing: 23 (2) ; 2010.
3. Saini K. Toppo K. Seema M. CPA 1986 : A Challenges to the Nursing
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4. Aerialacer. and Lawsuits : A Medico-Legal Perspectives.General Nursing
Discussion. 25 March 2010.
5. Allwin S.Examining Medication Error. The Journal of Nursing: 1 (1) ; 2007.
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Link. 2013.

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15. Malaravinzhi S. Samson R. Knowledge and attitude of Nurses on Legal Aspects
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