backdated MARs, med errors, & me in the middle

  1. Tonight I had a message from the nurse manager at work on my machine. She said she was calling because there were blanks on the MAR for a patient's IV ABX on both Saturday and Sunday night which is my regular weekend assignment. She said she needed to know if the patient even received the ABX over the weekend.

    I thought about it and came to the conclusion that there had to be something wrong with the MAR. I could see myself possibly overlooking a scheduled medication once, but not twice. I am very conscientious about my work so overlooking the drug is out of character for me.

    I went to the facility tonight off the clock to look at the MAR and try to figure out what happened. What I saw was that the IV MAR was apparently created and placed on the chart Monday. Previously the man was receiving the ABX on the day shift. The dates start with my shift and of course the person who made it made some nice big circles to show it wasn't given. I know who made the MAR because I know everybody's handwriting. Of course there isn't any way that I can prove it was backdated. Similar things have happend on this unit before with backdated records and certain nurses covering themselves by placing blame on the rest of the nurses.

    I'll have to call the NM tomorrow to see what they intend to do. I'm sure that they will do some kind of disciplinary action against me. I don't feel like I did anything wrong, but I'm sure I'm going to get it just the same.

    I would think that this would classify as a med error and that at most it would warrant a written disciplinary. A co-worker of mine did say that she thought they could push it as patient neglect and say that I had a responsiblity to check on the status of his IV meds even though it wasn't on the MAR. She suggested I sign it out tonight to prevent that. I DID NOT sign it out tonight though because I know they can really burn me for falsifying. Can anyone tell me how far they can push this? This is making me quite nervous. Any advice on how to follow up on this?

    Thanks in advance for any input.
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  2. 8 Comments

  3. by   moia
    Hold on a minute..if you truly believe another nurse falsified the MAR it is your obligation to report this immediantly. If a nurse could do this what else is she doing that no one has discovered yet?
    I would go right ahead with that MAR and tell the manager that this MAR has been changed.
    Don't accept this, if you let her get away with it she may escalate this behaviour and someone could be injured badly.
    I would go into the meeting and clearly state this error is NOT yours...show them the MAR from the week before that shows the med was a day shift responsibility...their has to be reason why this med was changed to night shift and it has to be documented on the dr's order sheet or the nursing notes why it was changed on friday/saturday before you came to work..
    If they do prove that you made the med error you will be cautioned..how they treat you will depend on your past work history...if you have a spotless record and your error caused NO HARM to the patient you will probably get a written warning and may be asked to take a med refresher course.
    If your error caused direct harm to the patient and they can prove the error was yours then things are going to be alot different....you may need to consider getting some legal advice if you know the missed meds have harmed the patient.
  4. by   FROGGYLEGS
    I fully intend to let the NM know that the MAR was backdated. Whether she believes it or not is a different story.

    The patient hasn't suffered any apparent harm. When I paid my visit tonight he was perfectly fine. I also read all of his nursing notes and nothing out of the oridinary has been documented. He isn't documented as having any c/o or anything to indicate distress of any type.

    I also don't have any prior disciplinaries. I've worked at this place for 18 months without anything of this nature.

    I will go through his orders tomorrow. I wish had thought to do so tonight.

    Thanks for the input, moia. It helps.
  5. by   jemb
    I'm a little confused about what happened.

    Are you saying that there was no IV MAR over the weekend, and that you gave no IV abx since there was no MAR? In other words, an order was missed somehow. Another nurse found the order and backdated the MAR to show that the abx were not given. If that is the case, several people made mistakes -- whoever should have transcribed the order and whoever should have given the abx, whoever was responsible for verifying that the order had been transcribed correctly. If you are one of those responsible, you may be disciplined, but, I agree that it should be treated as a med error and not as negligence.

    Or, since you say that the abx were given on day shift before, are you saying that another nurse changed the scheduled time thereby incriminating you ? ( And possibly directing attention away from herself) If so, you need to point out to the manager that the previous MARs indicate a different scheduled time, and, "of course you didn't give them. Why would you just arbitrarily change the med schedule?" You don't need to point fingers. Other people can compare handwriting, too, and can determine when the med should have been given to stay on schedule, and which nurse actually made the error.
  6. by   Tweety
    Is your signature on the falsified MAR?

    Stick to the facts. The fact is you never saw that MAR and you never signed it. According to your memory the patient had no antibiodics due on your time. How that MAR suddenly appeared is a mystery the manager needs to uncover.

    Obviously someone is trying to cover up their actions by making you look bad. What a horrible immoral and scarey thing for a professional to do.

    Good luck.
  7. by   FROGGYLEGS
    Jemb:

    No, there wasn't a MAR over the Weekend. That is why I didn't give the medication. The ABX was started over a week ago but was scheduled on day shift. The order was originally handled properly, but no new MAR was put in the book when the old one should have been carried over. The medication time was changed last Wednesday to 10PM. I know there wasn't an order to change the time. Changing medication times from days to nights for no good reason has been one of my complaints in the past. I addressed this with management, but they chose not to do anything about it. I don't think the time change was done to incriminate me, but rather to get it off of day shift.

    Also we keep a 24/hr report book that is supposed to list all patients on ABX. This particular patient wasn't listed as being on ABX on either Saturday or Sunday.
  8. by   FROGGYLEGS
    Quote from 3rdShiftGuy
    Is your signature on the falsified MAR?

    Stick to the facts. The fact is you never saw that MAR and you never signed it. According to your memory the patient had no antibiodics due on your time. How that MAR suddenly appeared is a mystery the manager needs to uncover.

    Obviously someone is trying to cover up their actions by making you look bad. What a horrible immoral and scarey thing for a professional to do.

    Good luck.
    No, I haven't signed it. Tonight was the 1st time I got to see it. As of midnight there was only one signature on it.

    Thanks all for the advice.
  9. by   TracyB,RN
    If I didn't know any better, I would say we worked at the same place. . .
    Similar events occur at my place of employment, too. ..
    Occurences get filled out, but nothing ever REALLY happens to help fix the system errors.
  10. by   FROGGYLEGS
    It can't be the same place, but if it reminds you of yours...I'm sorry Wouldn't wish that on anybody. I've seen some things at other facilities similar to this on a much smaller level. Unfortunately, I think scheming coworkers are almost everywhere.

    Quote from TracyB,RN
    If I didn't know any better, I would say we worked at the same place. . .
    Similar events occur at my place of employment, too. ..
    Occurences get filled out, but nothing ever REALLY happens to help fix the system errors.

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