[medicarelpn]

I will try to make this as brief as possible but I would like to know what you all think. A friend of mine who works at a different long term care facility than I do called me at work yesterday and asked me to come over to her house when I got off of work, because she needed to talk to me. When I got to her house she was on the phone with her DON. When she got off the phone she told me a couple of weeks ago they had a resident that was admitted to her facility on Saturday evening, the nurse that did the admit (not my friend) wrote up her medication orders. This lady was 57 and had been in the hosp for MI, she had an order for coumadin but the order was not clear so she wrote pending on the order and it was supposed to be followed up on the next morning by calling the docter. This nurse also wrote on the med sheets Coumadin (pending). Well 4 days went by and no one followed up on the order. On the fourth day she was admitted to the hospital with a blood clot and died. Her DON wanted her and all the other nurses to write statements that pretty much stated that they were negligent, she told my friend that this would go no further than her and the administrator. The family is irate understandibly so, my friend was so upset that she may lose her liscense I didn't want to tell her that she was partially at fault as she along with the other nurses did not followup on this order. But I did suggest to her she not put anything in writing until she talks to a lawyer. What are your thoughts on this? What advice should I give her?

[earle58]

i believe she has to write an incident report anyway....that's just a part of any p&p.
did your friend say why she did not call the md to verify orders?
on any new admit, we always had to verify the meds.

sorry, but coumadin is one drug that you don't write 'pending' esp w/a dx of an mi.
i'm hoping she takes responsibility on her end of it.

i wish her well.

leslie

[Bird2]

Originally Posted by earle58

i believe she has to write an incident report anyway....that's just a part of any p&p.
did your friend say why she did not call the md to verify orders?
on any new admit, we always had to verify the meds.

sorry, but coumadin is one drug that you don't write 'pending' esp w/a dx of an mi.
i'm hoping she takes responsibility on her end of it.

i wish her well.

leslie

I agree. The MD should have been paged to verify the order and an incident report should have been completed.

[psychonurse]

With the diagnosis of MI and on Coumadin and a hard to read order for it, I would immediately call or page the doctor and make sure that he took care of that order then. Coumadin is not something that you mess around with. I would have never left that order waiting for someone else to call the doctor in the morning...And if the doctor gives you a bad time then he is an *** also....

[Daytonite]

Whoa! Whoa! Whoa! Before this goes any further. You're an LPN, right? We're talking about this patient being in your facility for 4 days. Which RN reviewed these orders? Some RN was supposed to. Where was your MDS and care plan nurse in all this? There should have been all kinds of people evaluating this patient for her first few days. Especially on Monday morning. Please don't tell me this was a Medicare patient.

[casper1]

While this is a serious med error. I question if this caused her death. Coumadin has a very long half life.I have had surgical patient's in the hospital 2 weeks just waiting for their blood Ptotime to come down to a level safe for surgery. If the patient was at a theraputic level when she was discharged I question if he protime would come down that quickly.

[Daytonite]

I worked in long term care for a number of years and it sounds like this facility may have a problem with communication. We did a lot of faxing to the doctors offices because we could never get in touch with these docs. However, we had a system in place so we knew whether or not we had gotten responses back from our faxes. Somebody dropped the ball here. Who was supposed to follow up on Sunday morning? There was a doctor somewhere on call. I would have kept calling the answering service and telling them it was an emergency until I got a live doctor on the phone.

The nurses who passed the meds on Sunday, Monday and Tuesday flubbed up big time. Someone should have left a big sticky note, paper clip or something else to get everyone's attention on that patient's medication sheet that her doctor needed to be called. Didn't anyone notice that the patient had no Coumadin in her medicine drawer? Where was the pharmacy, by the way, in all this?

It was state law where I worked that we had to contact the admitting doctor within 24 hours to verify his orders voice to voice or get his signature. If we could not reach him we had a "house doctor" who we could reach 24 hours a day to help us out with this kind of problem.

Your friend does not need to talk to a lawyer unless she is served with a lawsuit. Let the nursing home handle this. They have some explaining to do because it sounds like they did not have communication systems in place to deal with a situation like this and there is inadequate supervision. I think Casper1's previous reply is right on. I don't think your friend is going to lose her license. But she should learn a good lesson from this. Question everything. Be particularly careful with new admissions in nursing homes. Goof ups on nursing home admission orders happen a lot more than you would think. If she can't get answers then pass the buck to the supervisor and put the ball in her court. When you are an Indian you are always safer when you pass the buck and let the Chiefs figure out what to do. Nursing homes are under a lot of scrutiny because of things like this happening. I still say that with this being a new patient there should have been a slue of people just pouring over this chart and assessing this patient in order to work up the care plan and prepare the MDS. Someone should have caught this.

Tell your friend not to alter this patient's medical record in any way or make any written statement indicating that she was negligent as that is as good as saying, "I'm guilty, I did it."

[earle58]

Originally Posted by casper1

While this is a serious med error. I question if this caused her death. Coumadin has a very long half life.I have had surgical patient's in the hospital 2 weeks just waiting for their blood Ptotime to come down to a level safe for surgery. If the patient was at a theraputic level when she was discharged I question if he protime would come down that quickly.

i don't think that's really the point here.
whether her pt/inr levels were in therapeutic range is irrelevant to the handling of the admission.
chances are she was a medicare pt to receive various skilled services. yet ot or pt wouldn't even look at her meds.
and yes, it was erroneous of all the other nurses that did not question the coumadin orders.
but the bottom line is whoever did the admission, was responsible for verifying meds. and coumadin is a drug that you do not wait til the next day. we're not talking about colace here.
and i've seen pt/inr's drop to sub-therapeutic levels in a few short days.

but the nurse who did the admission needs to fill out an incident report, stating the facts and only the facts.

leslie

[Mulan]

Don't you have to be 65 to be on medicare?

[Bird2]

Originally Posted by Mulan

Don't you have to be 65 to be on medicare?

If they are on disability they can be under 65. We have had only a few resident under 65 and they are usually short stays.