By R.L. Nussbaum, R.L Molness
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B. Runciman, W. J. Russell, A. Sellen, R. K. Webb and J. A. Williamson, `The ``wrong drug'' problem in anaesthesia: an analysis of 2000 incident reports' (1993) 21 Anaesthesia and Intensive Care 596±601. J. B. Cooper, R. S. Newbower and R. J. Kitz, `An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection' (1984) 60 Anesthesiology 34±42. G. D. Smellie, N. W. Lees and E. M. Smith, `Drug recognition by nurses and anaesthetists' (1982) 37 Anaesthesia 206±8.
J. ), Medical Accidents (New York, Oxford University Press, 1993), 116. 28 Errors, Medicine and the Law knocks over a pedestrian. In the latter case there may be no intention to harm the pedestrian, but in fact, apart from the technical duty of care on the part of the driver not to cause harm to the pedestrian, there is no intent either way in relation to the particular individual. When a doctor accepts responsibility for a patient, there is an explicit intent to help that patient or at the very least not to harm him or her.
Yet we can see that the facts belie this understandable assumption. The truth is that errors of drug administration occur in all medical and nursing disciplines in all countries. It is precisely because they are common but not immediately understandable that they are a good example of the type of error that pervades healthcare. In part, the issue is a lack of awareness of the complexity of some of the activities in question. Most people understand that a major surgical operation is a dif®cult undertaking, but it is perhaps less widely appreciated that an anaesthetic may often involve the administration of twenty, and in some cases more than ®fty, intravenous boluses of drug.