No wonder patients are in pain!

[PeachPie]

I just got a call stating that I am on unpaid suspension because of a drug waste discrepancy. I had a shift consisting of 4 (count 'em 4) confused, agitated men swinging at us and trying to get out of bed. One of them was in a procedure where the doctor needed sedation NOW. I lost that half vial of Ativan, creating a discrepancy when I finally did get around to wasting. Yeah, I should have wasted it right then and there, but dumb me tried to be quick. I know that my drug screen will come back clean, but until then, I'm sitting at home not being paid. This is bull crap. I know that it's to protect me and them, but the last thing I need right now are druggie accusations.

Don't get me wrong, I would never leave a patient in pain, but between all the JCAHO documentation for pre-and-post-medication, having to waste everything even if you have multiple patients in pain and no nurses in sight, it's no wonder why pain isn't better controlled and treated than it is! I've even had a few nurses and doctors tell me not to ask if the patient is in pain, as that will "encourage/remind them." Again, I would never leave someone in pain, but I can see where they're coming from and reducing their own personal liability with the "don't ask" policy.

[PeachPie]

Thanks for caring. No, I have not heard from them still. The incident happened one week ago today. I'm hoping to hear from them tomorrow.

I'm actually getting paranoid, as in, "When I wasted Ativan, it squirted all over my hands. Maybe a minuscule amount absorbed transdermally?"

[PeachPie]

I got terminated today. They reviewed my Accudose history, and found that a lot of drugs had been given too far after drawing, and that there were 2 counts of unwasted drugs. I will be reported to the board even though my drug test was clean. I'm not trying to sound irresponsible, but almost every nurse I've talked to has admitted that she's forgotten to waste in the past.

I'm worried about getting rehired. I have 5 months experience of LTAC, and I just completed my 3rd month of this current job. Most places don't even consider you unless you have a year of experience.

[morte, LPN, LVN]

I got terminated today. They reviewed my Accudose history, and found that a lot of drugs had been given too far after drawing, and that there were 2 counts of unwasted drugs. I will be reported to the board even though my drug test was clean. I'm not trying to sound irresponsible, but almost every nurse I've talked to has admitted that she's forgotten to waste in the past.

I'm worried about getting rehired. I have 5 months experience of LTAC, and I just completed my 3rd month of this current job. Most places don't even consider you unless you have a year of experience.

there but for the grace of.....go so many hosp/ltach nurses.......it would seem that all need to keep records of when codes happened or other major events, that would have delayed med adm after withdrawl from the "god" pyxis.....maybe an incident report on yourself would be better than what is happening now? also check the internal clocks of these machines....make sure they are accurate.....and how long is too long?....good luck

[Ruby Vee, BSN]

this is a way more appropriate place for this post i wrote elsewhere ay o'dark thirty. maybe mod will delete other?

anyway, don't know how new or interesting this might be for anyone but fwiw

anybody ever peruse the 'disciplinary actions' section of your state bon site?

since we all(and even if you haven't done this particular mistake like op, don't worry, there's somethin' here for almost everyone) know that real world nursing is rarely the utopia of school/nclex-like practice scenarios where there is staffing and 1to1 care available for all

but even i was a little taken aback by some of the egregious offenses listed. oh and the bolded emphasis is theirs:

1. respondent removed 8mg. morphine from pxysis when physician order was for 4mg.

(no issue w/wastage btw, that appears all good, just the discrepency in what was ordered vs. removed)

oooohhh...

2. respondent removed 'whatever' at 2335. documented medication given at 2330, however this was fully five minutes before med removal.

3. respondent adminstered 'whatever' according to md order and patient was d/c at 1300. wasted 'appropriate amount' with 'appropriate witness' at 1341. however, this was almost 45 minutes after patient left department.

let's see......only comes in 8's

my watch/yer computer's off,

wth? i couldn't get anyone in to waste w/me until then and oh yeah, bed c decided then would be good time to, y'know, code...

don't know why i'm surprised anymore, and yes i know they're there for the public's protection and not ours, and no, these aren't mine nor am i in any trouble...

just over the the ability to make how-it-is-sometimes appear all shadyand suspicious...

anyway, just found that section today and it really teed me off.

it kinda looks like someone is on the (bad word that means fecal material) list -- it's almost as if they had to scrounge for problems to document. who among us has not wasted a med an hour (or 11 hours) later? who among us has not charted a med before we removed it from pyxis because the clock on the computer on pyxis is 7 minutes slower than the time on the e-mar? and if the ordered dose is less than the unit dose, how in the world are you supposed to withdraw only the allowed amount? what bothers me is why would someone be trolling for "med errors" like this? it sucks!

[Ruby Vee, BSN]

i got terminated today. they reviewed my accudose history, and found that a lot of drugs had been given too far after drawing, and that there were 2 counts of unwasted drugs. i will be reported to the board even though my drug test was clean. i'm not trying to sound irresponsible, but almost every nurse i've talked to has admitted that she's forgotten to waste in the past.

i'm worried about getting rehired. i have 5 months experience of ltac, and i just completed my 3rd month of this current job. most places don't even consider you unless you have a year of experience.

i'm so sorry.

it seems that the system is flawed -- there's no way to be absolutely in compliance with it. it does make me wonder, though, whether you think they could have been "after you."

[PeachPie]

it kinda looks like someone is on the (bad word that means fecal material) list -- it's almost as if they had to scrounge for problems to document. who among us has not wasted a med an hour (or 11 hours) later? who among us has not charted a med before we removed it from pyxis because the clock on the computer on pyxis is 7 minutes slower than the time on the e-mar? and if the ordered dose is less than the unit dose, how in the world are you supposed to withdraw only the allowed amount? what bothers me is why would someone be trolling for "med errors" like this? it sucks!

everyone has errors like this on the records. i talked to my now former charge nurse last night, and she admits that she's had mistakes like that and that every nurse on the unit probably has an accudose record looking something like mine. i was stupid and honest and asked the house supervisor what to do, which called attention to my mistakes. i'm sorry to say this, and i know it's going to sound bad, but you can't be honest like that in this field. they're out to get you and will not cover your butt for you. yeah, i'll be the best nurse i can be, but i've deduced that at any one time, pretty much no matter what, i'm breaking one of the millions of violations set by facility, jcaho, hipaa, nurse practice act, etc. i feel so d*mned.

i definitely learned from my mistake. i'm never going to draw without wasting right then and there to cover my butt, screaming patient be darned. yeah it sucks, but again, i need to preserve my butt. the really crappy thing is that if i hadn't said anything, probably nothing would have come of it. how's that for morale?

when i was terminated, the nurse manager said that she's going to turn this into the texas board of nurses. i'm scared. i'm definitely writing down my side of the story, but i'm still scared about them investigating.

i too wonder if it was just this or other offenses making them want to get rid of me. i was actually in good standing, with only one verbal warning for an absence in which i didn't know i was scheduled to work. i was given no warnings about the accudose stuff. then again, texas is a fire at will state.

[morte, LPN, LVN]

sending you a pm

[pennyaline]

Even in at will states, your employer cannot make up reasons to fire you or accuse you of things you haven't done. If it can be proven that they did that, you might have a case for wrongful termination.

But this doesn't seem to be one of those cases. They gotcha, for something as silly as not doing a witnessed waste. The discrepancies between when the Pyxis says you took a med out (I hate those machines with a passion!) and when your MAR says you gave it is a minor thing that can be explained by comparing clocks, surveying activity on the unit or one your assignment at the time, etc... stuff happens. But not doing a witnessed waste will not be overlooked as it is a controlled med protocol. You won't do that again, will you?!:imbar:

I'm sorry that this happened and that you were caught in the middle. Start looking for another job and don't worry about the "what if's" at this point in time. Your BON handles these things on a case by case basis, and may or may not make something of this. Whatever happens, remain honest. Honesty will pay off in the end.

[canoehead, BSN, RN]

I got a complaint sent to the BON about me, and just heard back like 2 days ago. I worked the ER as the only RN, and had to give narcotics and waste them. So to waste I had to go to the other end of the building to find another RN and do the deed. I didn't think that was safe, leaving my patient without a nurse for that period of time, so I'd save the narc for the AM and waste with the oncoming shift.

Well about once every 6 months I'd forget to waste the leftover, and would be written up. The med was there, with a patient's sticker on it, and they could pull the chart and find out how much I gave and how much was left etc. OR, they could call me back in to do it- I was willing to come back if I forgot, but they never did that, I just got written up.

So I told all this to the BON, explaining all the suggestions I had that could fix the problem, lots of alternatives, and how I would remind myself, how the same situation was dealt with on other shifts, and the BON closed the complaint without action. Apparently they accept that nurses are unable to teleport or to midread (!). I also had sent several inquiring letters to the BON about their rules when I got the first few writeups, and enclosed the correspondence I had with my manager talking about alternatives. I suggest anyone having issues with their workplace write to clarify their position, just for documentation's sake. Acknowledging a problem and trying to find a solution doesn't happen unless it's documented. That documentation can save your butt when the BON gets involved.