Need advice on memo to all nursing staff that contains threat

[ms40]

to report all medication errors to state board of nursing.

A bit of background: I work in a State intermediate care facility for people with developmental disabilities. We are currently operating under a settlement agreement that is overseen by the US DOJ. As such there are numerous inspections, reviews, surveys, etc., to measure progress made toward fulfilling the requirements of the settlement agreement.

One of the most recent problems (approximately a month ago) noted by a particular surveyor was that a number of nurses had failed to sign the MAR after giving meds, treatments, etc. When this was revealed the DON and Chief Officer sent out a memo that outlined a new policy of progressive disciplinary action for making medication errors (not signing is considered an error), which to me, did not seem unreasonable. The memo left off by stating that this particular surveyor would return in a few weeks time to spend more time visiting with staff and residents which I am presuming was a bit of a "heads-up".

The surveyor made the return visit and found unsigned MAR's still an issue in some units. Some had been presigned (yikes!). There is no doubt in my mind that there are some big problems. Here's how the administration has chosed to deal with this issue. Yesterday, we received a memo from the DON and the Chief Officer regarding another new policy on disciplinary action for failing to sign the MAR or any other medication error. It is now facility policy to immediately fire a nurse that makes an error regardless of the circumstances. A strict "no-rehire" flag for negligence will be placed in the offender's personnel file and, I assume also passed on to any future employer. The facility will also report any medication error, and the offending nurse, to the State Board of Nursing for investigation.

I suppose the facility can make any policy that they like, but this seems wrong on so many levels. What recourse would I have for example, if I get fired and reported to the BON for forgetting to inital the MAR on the 1100 administration of Boost Pudding for patient "X"?

I would appreciate any feedback, words of wisdom, etc., that any of you have to offer on this situation.

[Rapheal]

I am not perfect and working in an environment that induces fear is not for me. I would be so out of there. I do not believe that your management is utilizing productive ways to solve their problems.

[barefootlady, ADN, RN]

Sorry, but I could not work for a place that did not understand a reasonable mistake and give the nurse a chance to correct it when it comes to signing a MAR. I think coming in early is a bit much too, I have a life and I need to be able to live my life, not just live for the job. It sounds like chronic understaffing is a BIG problem here and the nurses are doing "the best they can do" under difficult circumstances. Perhaps the supervisor or HN needs to check every MAR everyday for a short period and see if there is a pattern. If there is one found, then try to address it in a constructive manner, not with threats of firing and turning in to the board. Checking the charts, MAR's and your patient assignment should be part of finishing up any day's work, so maybe if there is a few minutes at the end of the shift to be dedicated to this activity for the nurses, then the problem would be better addressed.

[elkpark]

Keep in mind that, according to the OP, the administration did not dream this policy up out of the blue. The facility is in trouble with the federal government for a pattern of medication errors that has not been corrected. I do this kind of inspecting for a living. When the inspectors do the first follow-up visit and find that the problem has not been corrected, there is greater pressure on the administration to fix the problem -- obviously, the original plan of correction they submitted to the feds did not fix it, so they have to "up the ante." The facility is looking at losing their license to operate and/or ability to receive Medicare/Medicaid funding. You do NOT want to have the feds (or even your state) breathing down your neck. The original inspection that identified the problem was trouble enough -- to have them come back for the follow-up and find the problem not corrected is serious trouble.

[jnette, ASN, EMT-I]

MAR's not signed? Nursing school 101, an action not documented is an action not done. MAR's presigned? Documentation that an action has been completed when it is not done. I believe that's fraud. I hate to say this, but I'm on administration's side here (and that happens VERY rarely).

From what you have written, inspectors came in once and found documentation errors and deficiencies. Your administration put out policy to try to correct this, which by your own admission was a reasonable policy. Administration even gave you a heads up that the surveyors were going to return. When they did return, they found nurses continuing to commit the very same errors. The "reasonable policy" was ignored by the nursing staff. Were I an administrator of this facility, I'd take pretty drastic steps, too. Sounds to me like a hostile staff that would rather see the facility closed than document properly.

Whether the medication was "boost pudding" or insulin, if it is ordered, it must be administered, and the administration must be documented. If it is not administered, that must also be documented along with the justification (i.e. patient refusal). All nurses learn that in the first semester of nursing school.

Kevin McHugh, CRNA

Yeah... I'd have to agree here, too. While it DOES appear a bit harsh, I, too, believe that it has been an issue that has been going on for way too long, and not taken seriously by the nurses. Seems like this is what it had to come down to in order for it to be taken seriously. After all, the place can be closed down if the inspectors continue to find noncompliance issues.... not to mention the obvious necessities of proper documentation to prevent serious medication errors form occuring.

I don't think ANY of us are perfect, but get the feeling that this is more than just an occasional omission... or they would not have gone to these extremes.

I do agree with Fergus on the " regardless of circumstances" clause, however.