For NPs, it is worth noting some of the top areas
of risk for pediatric emergency care, which include:
 Communication breakdowns during transitions
of care and handoffs.5 The patient may initially
see one NP on arrival and be transferred or
assigned to a registered nurse or other NP, or
be referred to his or her primary care provider.
There may be a verbal, recorded, or written
report about the transfer, but it may be
ineffective.6 Communication problems and
ineffective transitions of patient care can lead to
inadequate treatment, unnecessary errors, excess
pain, and even death for the patient.7 In turn,
this may result in charges against the NP for
failing to follow standards of care, among other
charges.
 Barriers to obtaining presenting problems and
adequate histories.5 Children, especially those
who are very young and are nonverbal, must
depend on parents or other caregivers to
provide information. In addition, cultural and
language differences may impede the ability of
the NP when taking a complete history. Also,
in rare cases, an adult caregiver may directly
produce or lie about illness in a pediatric patient
under his or her care (Munchausen syndrome
by proxy). Regardless of the cause, an
incomplete patient history (or disregard of a
patient history, drug use, etc) may lead to
inadequate treatment or other serious issues for
the patient, and a professional liability lawsuit
against the NP or a BON complaint.
 Ensuring safe medication prescribing and
administration.5 This is vital because, when
medication errors occur, pediatric patients have
a much higher risk of death than adults.8
Medication errors are serious and may lead to
charges of gross negligence for the NP. The
following brief case study demonstrates the
devastating effects of a medication error: a 15-
month-old patient presented to an ED with a
high fever and urinary tract infection. The NP
ordered azithromycin 800 mg intravenously,
which was corrected by the pharmacy to 80 mg.
However, the registered nurse filled 2 syringes
each with a 500-mg dose and administered 800
mg based on the NP’s written order. The patient
became unresponsive and died. Lack of
communication was an intervening factor.