Delayed Dependent Adult Abuse Reporting

Nurses General Nursing

Published

I am in the middle of an absolutely horrible incident and would like some people's opinions.

I work in a forensic, psychiatric hospital as an RN. The majority of my coworkers are psychiatric technicians (similar to LPN). Recently, we had a patient who was very disorganized, confused, and a significant falls risk. His condition had been deteriorating significantly since his antipsychotic medications were decreased due to an ECG abnormality earlier in the week and had not slept in several days.

Shortly after the medication pass, the person administering medication stated to me that she hoped he would sleep because she "gave him a PRN of Ativan". I did not think that this patient had ativan ordered so I alerted the only other RN on duty of this and we looked at the MARS to investigate. The medication person came into the med room at told us that she had given him Ativan even though it was not ordered but that it was "okay" because "he doesn't have an Ativan allergy". She then said "I'm just going to say [another patient] took it".

My coworker and I were shocked by this event and reported this to our shift lead who didn't seem to care and suggested that this occurs commonly. Just before the end of my shift the employee came up to me in front of numerous staff and angrily informed me that she was aware I was discussing this and if "the AM shift found out" she would know who to come after.

The following morning I reported this to my supervisor and an SOC341 was filed.

My concern is that per my hospital's policy, this should have been reported before the end of my shift and it was not. California law requires that this be reported within 24 hours (which it was). I realized that this took place at about 2130 and alerted my shift lead at about 2230. My shift ended at 2315 and I had to return to work at 0630 the following morning. A second concern is that while I assessed the patient that shift, I charted my assessment as a late entry because I had already stayed well beyond the end of my shift and I had to return so early. I was unable to get to charting because the patient's behavior was so unstable that he required multiple staff to be with him on a near-continuous basis.

Anyone ever been in a remotely similar situation?

You reported it to your immediate supervisor and went further up the chain after realizing that the issue hadn't been addressed. I don't see how you're at fault in any way, although I admit I'm no legal expert.

Specializes in Med/Surge, Psych, LTC, Home Health.

No I haven't, but it sounds like you did absolutely everything about the

situation that you could personally do. Don't know what else you

should have or could have done. Now you just have the angry

coworker who is angry that you reported him/her. Well, let them

be angry, you did what you had to do.

You reported it to your immediate supervisor and went further up the chain after realizing that the issue hadn't been addressed. I don't see how you're at fault in any way, although I admit I'm no legal expert.

While I keep telling myself this, this doesn't leave me feeling relieved. One major problem is my immediate supervisor that night (who did nothing) was just the acting shift lead that night and his license is lower than mine (he is a psychiatric technician). While I did assess the patient, a late entry assessment is significantly inferior to one that was documented at the proper time. Furthermore, while it seemed reasonable that the alleged medication did not harm the patient, I'm not qualified to make that judgement.

My actual supervisor (who is also a psychiatric technician) says that my management is supportive of what my coworker and I did although we did not follow policy. She says the most likely discipline will be a letter of instruction that will be removed from our files in 6 months. She did mention that administration wondered why SOC341s weren't filed on us for patient neglect and it is possible that administration will override whatever disciplinary action my management elects to take. It is worth noting that I have been allowed to report to my workplace since this incident took place while the person that administered the medication is not allowed on hospital grounds.

Specializes in tele, ICU, CVICU.

Unless I am misunderstanding what happened, how could YOU get in trouble? You did not give a med that was not ordered for the patient. As soon as you knew they received an unordered medication, you went up your chain of command to report it. And you and another RN both heard the medication-giving-tech state she was going to falsify documentation. And then she basically later said "I know you're talking about it so I'm coming after you if anything happens regarding my actions." WOW. Is this other RN with whom you researched the MAR & witnessed this crazy statement from tech saying otherwise now? I would hope he/she doesn't change their story regarding what happened, because of stupid workplace petty Cliques and who the 'in' crowd is. Plus, other staff witnessing her statement about going after you should anything happen, is good, that others have witnessed statements.

Regarding the late entry charting: if the patient was having issues and what not, requiring such close supervision all shift, I'm sure that would be reflected in the charting. Unfortunately late documentation is going to happen when issues arise.

Why would you two RN's have something filed against you, stating patient neglect? I don't see how anything you did falls into that category. If I'm understanding correctly, you reported the issue to shift lead at 2230. And then at 0630 filed the SOC form, and CA law gives you 24 hours to submit SOC form. When you say the policy at your facility is to report on same shift, I assume you mean employer wants the form done on the same shift, not merely reporting to supervisor working at the time of incident? This is the ONLY thing I could understand you & other RN getting any type of official discipline for (which still is a little much, IMO, given the issues and timing circumstances. However, I'm sure others have not completed form within 24 hours and they simply want to ensure compliance).

It's a good sign that you are allowed back to work, whereas the medication tech is not. However, being told administration may override your supervisors' actions leaves one to wonder what else they have in mind.

Maybe I'm missing something, but it doesn't sound that you & other nurse did anything wrong. Other than having another co-worker upset with you, I don't see why you should worry (but that's easier said than done.) I find it more concerning the shift lead person seemed to not care and gave the impression this is a common occurrence in that facility. Not a good situation.

Please let us know how things progress; I'm curious if they will terminate the med person or try to take things out on you. Best of luck

:-)

Unless I am misunderstanding what happened, how could YOU get in trouble? You did not give a med that was not ordered for the patient. As soon as you knew they received an unordered medication, you went up your chain of command to report it.

I wouldn't say it was as soon as I knew, but rather within an hour or so. I think the main complaint administration has is that because we did not complete the SOC that same shift, it is plausible that rather than assess the patient to make sure he was unharmed, we instead tried to plot a way to hide that this ever happened and then turned her in when we realized we couldn't. Since all documentation regarding the patient's physical status is charted as a late entry, this (wrong) assumption is slightly more plausible.

And you and another RN both heard the medication-giving-tech state she was going to falsify documentation. And then she basically later said "I know you're talking about it so I'm coming after you if anything happens regarding my actions." WOW. Is this other RN with whom you researched the MAR & witnessed this crazy statement from tech saying otherwise now? I would hope he/she doesn't change their story regarding what happened, because of stupid workplace petty Cliques and who the 'in' crowd is. Plus, other staff witnessing her statement about going after you should anything happen, is good, that others have witnessed statements.

No, the other RN is a close friend of mine. We have discussed at great lengths our versions of the story and they are essentially identical. We're both equally fearful of disciplinary action we may receive because one could argue we temporarily tried to hide this rather than report it.

Why would you two RN's have something filed against you, stating patient neglect? I don't see how anything you did falls into that category. If I'm understanding correctly, you reported the issue to shift lead at 2230. And then at 0630 filed the SOC form, and CA law gives you 24 hours to submit SOC form. When you say the policy at your facility is to report on same shift, I assume you mean employer wants the form done on the same shift, not merely reporting to supervisor working at the time of incident? This is the ONLY thing I could understand you & other RN getting any type of official discipline for (which still is a little much, IMO, given the issues and timing circumstances. However, I'm sure others have not completed form within 24 hours and they simply want to ensure compliance).

Yes, policy requires that the form be completed before going home. The SOC form was filed by my supervisor at about 1130, so it was not at the start of my shift but rather several hours into the shift after I spoke with the AM medication person regarding this incident. She had been suspicious that this may have taken place because she talked to the patient that was documented as having received the med and he denied receiving it. She also questioned why the med was documented as being given at the time listed as the patients are not on the unit at that time, but rather eating dinner in the dining room. In order for a patient to receive a PRN of Ativan during meal time, something serious would have had to take place requiring the patient to be brought back from the unit. Since this did not happen, it makes absolutely no sense that the patient would take Ativan during meal time.

It's a good sign that you are allowed back to work, whereas the medication tech is not. However, being told administration may override your supervisors' actions leaves one to wonder what else they have in mind.

This is my concern. The people that will ultimately decide my fate are a social worker and a recreation therapist who just happen to make up upper management at my facility and supervise all nursing staff despite not being nursing staff themselves.

Please let us know how things progress; I'm curious if they will terminate the med person or try to take things out on you. Best of luck

:-)

While nothing is official, I was told that it is essentially guaranteed this person will be terminated (which is no easy feat at my hospital as permanent employees are nearly impossible to fire). The investigator I talked to said they are pursuing criminal charges against this person for illegally dispensing a controlled substance.

One last interesting piece of this story is a stat urine drug screen was ordered about 36 hours after this event and it was negative for benzodiazepines.

Specializes in Family Nurse Practitioner.

This sounds like a mess from the top down but it doesn't sound like you did anything that could be considered negligent and speculating as to why the delay in reporting was to cover things up is far fetched. I believe you did the right thing however no matter how late you are or how early you need to return when an adverse event happens it is never a good idea not to finish all the necessary documentation prior to leaving the facility. I'm wondering if this is a state facility since most forensics are now and you said employees are difficult to terminate. FWIW in my area psych-techs don't even have to be CNAs or medicine aids so not similar to a LPN. Hopefully there aren't unlicensed people passing meds and this gets handled appropriately. Perhaps it is time to consider if this is a safe place both for your patients and your license.

This sounds like a mess from the top down but it doesn't sound like you did anything that could be considered negligent and speculating as to why the delay in reporting was to cover things up is far fetched. I believe you did the right thing however no matter how late you are or how early you need to return when an adverse event happens it is never a good idea not to finish all the necessary documentation prior to leaving the facility.

Based on what I was told today, the main concern is whether I in fact assessed that the patient was unharmed in a timely manner. The patient required nearly continuous monitoring due to his underlying behavior/ mental status so I feel it is reasonable to say that I did (along with the other RN on duty).

I'm wondering if this is a state facility since most forensics are now and you said employees are difficult to terminate. FWIW in my area psych-techs don't even have to be CNAs or medicine aids so not similar to a LPN. Hopefully there aren't unlicensed people passing meds and this gets handled appropriately. Perhaps it is time to consider if this is a safe place both for your patients and your license.

Given that this investigation is ongoing, I don't want to say specifically where I work, but your assumption is a good one. In my state psychiatric technicians are licensed and go to school for 12 months prior to licensure.

+ Add a Comment