Ethical advice needed for a new grad...

[AnnaleaRN]

What would YOU do?

Say, hypothetically, that you are a new graduate RN at your first job. During morning med pass at a SNF, you witness another RN entering incorrect times for med administration on multiple patients in order to seem like everyone received their medication within the designated time frame. When you asked this nurse about the times, she states that she "guesses every nurse has to make a judgement call on how to chart."

Would you take it further? Would you ignore it?

[nurseprnRN, BSN, RN]

For my money, if a med is given within the hour plus-or-minus, charting that hour is fine. Now, if you have someone on Q4h antibiotics, due at 08-12-16-20-00-04, then obviously giving them at 09-11-17-19-01-05 might not give the coverage you need (depends on peak/trough levels) but it still gives six doses in 24 hours, and I would chart them at 08-12-16 etc. This is not falsification, which by definition seeks to lie for the purposes of covering up.

Obviously a QD or BID med has less need for precision in dosing. If you are on a BID antibiotic at home and you decide to take it at 06 and 18, and your alarm doesn't go off and you take it at 0745 when you wake up, is your therapeutic regimen compromised? No, of course not.

I guess what I'm trying to say is that as you gain experience you'll see the big picture better and rely less on the minutia. Yes, I think this is perfectly acceptable in the context of the completeness of patient care.

[Pangea Reunited, ASN, RN]

I chart accurately- even if my meds end up given very late. I've seen people do it other ways, and in most cases, it doesn't grab me as an issue. I can think of one exception, though...

I was assuming care of a patient from a nurse who was going home early. Patient's SBP was just over 200. I saw (in the MAR) that she received a few blood pressure meds about four hours prior, but the nurse actually had NOT given them yet and went to give them before she left. The nurse became pretty irate when I politely asked her to correct the administration times, but leaving them "as is" would have made it look like I did nothing about the patient's out of range vitals. The MD might also have come by the next day and increased her BP meds thinking that her current doses were ineffective.

So, in some cases, it does matter and something should be said. In most, it probably doesn't.

[Spidey's mom, ADN, BSN, RN]

I chart accurately- even if my meds end up given very late. I've seen people do it other ways, and in most cases, it doesn't grab me as an issue. I can think of one exception, though...

I was assuming care of a patient from a nurse who was going home early. Patient's SBP was just over 200. I saw (in the MAR) that she received a few blood pressure meds about four hours prior, but the nurse actually had NOT given them yet and went to give them before she left. The nurse became pretty irate when I politely asked her to correct the administration times, but leaving them "as is" would have made it look like I did nothing about the patient's out of range vitals. The MD might also have come by the next day and increased her BP meds thinking that her current doses were ineffective.

So, in some cases, it does matter and something should be said. In most, it probably doesn't.

This is pretty close to an example given by one of my mentors. You just don't want to go down that road.

Again, we have to live with what we put up with.

[CaitlynRNBSN]

I don't know what its like to work at SNF, but I would stay out of it. No harm is being done (unless its like 4 hours from when it needs to be given).

Usually medications it doesn't matter that much if it is an hour or two late. Medications are ordered "daily" or "2 times daily" as long as they get it "daily" does it matter if it was given at 7am or 9am?? Not really. Yes, there are some exceptions but for the vast majority of medications it doesn't matter. Even medications that have a designated time will say something like "Take 1 pill in the evening"...well, that could be 6pm-10pm. So is harm REALLY being done if the patient gets his Zocor at 10pm rather than 8pm?? No.

again, there are exceptions to the rule (i.e. giving an opioid too close together)

[valeriamariaflynn]

We scan our meds and so we can't ever fudge our med admin times. We can edit, but the time of the edit is also recorded. I work on a busy med Surg unit and with multiple patients and acute situations arising regularly we have to give late meds sometimes. It is not held against us unless we don't chart a reason for each one. I never let it bother me because I work hard, have good time management skills and being only one person, I can only do what I can do. I don't apologize to management for late meds. Nurses that are slow and late all the time face getting written up.

It's a shame what is happening in nursing right now, we are forced to work under tremendous pressure to perform superhuman feats so that the hospital can make more money. And then if we make a big med mistake because we are rushed, a life or our license is in jeopardy. As a new grad myself let me advice you to protect yourself and be careful. I would question firs the ethics of a corporation that puts patients in danger by imposing such impossible standards on nurses.

[hope3456, ASN, RN]

What I don't understand is the state surveyors. They know this happens and they look the other way. All they are interested in is watching the CNAs wash their hands and do peri care, making sure the food is the right temperature, no expired meds in the emergency box, ect. Petty things. I wonder if they have been bought off by the LTC lobbyists.

During a federal survey, a surveyor came to watch me pass meds. He was very friendly, we chitchattef for a few minutes about where we were from, ect. Then as I started to open the Med cart he says under his voice, "hey let's not do anyone who has very many meds." Of course I know what to do when I'm being watched - not how we do it when we are being efficient.

I have thought about trying to report this - the best agency I can think of is Medicaid/Medicare abuse . Some of these meds are costing hundreds a month but probably not effective if not administered properly. Not to mention unsafe.

[xoemmylouox, ASN, RN]

What I don't understand is the state surveyors. They know this happens and they look the other way. All they are interested in is watching the CNAs wash their hands and do peri care, making sure the food is the right temperature, no expired meds in the emergency box, ect. Petty things. I wonder if they have been bought off by the LTC lobbyists.

During a federal survey, a surveyor came to watch me pass meds. He was very friendly, we chitchattef for a few minutes about where we were from, ect. Then as I started to open the Med cart he says under his voice, "hey let's not do anyone who has very many meds." Of course I know what to do when I'm being watched - not how we do it when we are being efficient.

I have thought about trying to report this - the best agency I can think of is Medicaid/Medicare abuse . Some of these meds are costing hundreds a month but probably not effective if not administered properly. Not to mention unsafe.

The problem with reporting this is that the Nurse is the one who will get blamed, not the facility who short staffs each shift. How is that fair?

[chrisrn24]

Talk to Brandon LPN or niceguybrian (?)I believe it was one of their facility who has staggered their med pass times to promote passing meds on time. I can't explain it well.

[classicdame, MSN, EdD]

the nurse is risking her license and allowing management to get away with creating an impossible situation. As long as she does it, management has no incentive to correct anything. If she gets caught, they just find someone else.

[hope3456, ASN, RN]

The problem with reporting this is that the Nurse is the one who will get blamed, not the facility who short staffs each shift. How is that fair?

Precisely. But it sounds like it is a problem everywhere - and BON doesn't seem to care. If enough nurses complained to CMS they might take action....maybe

[hope3456, ASN, RN]

the nurse is risking her license and allowing management to get away with creating an impossible situation. As long as she does it management has no incentive to correct anything. If she gets caught, they just find someone else.[/quote']

What do you suggest be done?

[elprup, BSN, RN]

What do you suggest be done?

We must all stand together and educate the public about what is truly going on.