Is this a Med Error? I have been kicked from clinical. Help

[nursing?s]

I' am in my last quarter of nursing and I was recently failed for my clinical portion 2 days from graduation. I looked into a MAR to see if a client could have a narcotic. Turns out the client had 10 min befor she could get it. The ten minutes passes and I go into the narc drawer and again double check the last time she had the medication and it was indeed time for her to get it. I signed the narc book and being a student needed a cosigner asked my instructor to cosign. She asked me where the MAR was and I told her it was in the MAR book. She said "so you want me to sign a med without having the order from the MAR? Its not safe!" and sent me home to fail the clinical portion and therefor have to repeat the theory and clinical portion next quarter. I'm fighting it but I wanted to know, has anyone else ever had a nurse/teacher co-sign a narc without the teach/nurse seeing the MAR first? As I thought the narc book only verifies the count I would always just have them cosign and then do my 3checks of the seven rights and administer the medication. Is/was this wrong or have any of you done the same thing? Thanks for your help

[Pepper The Cat, BSN, RN]

Were you getting the med from the MAR or just from the Narcotic Book?

If you were using just the Narcotic book than I see the instructor's concern. What if the med had changed since the last dosing?

What if the previous nurse gave the wrong med?

[DC Collins, ASN]

The problem is, if I understand it correctly, that *you* saw the MAR. If you have a co-signer, the co-signer *must* always see the MAR (or orders, or whatever you are working from) as well. They are signing saying that the order is correct with what you are going to be giving.

There is a reason for co-signing. In cases of students, its obvious. But in my ED, there are several meds that require co-signers (Insulin, certain cardiac drugs, any peds IV meds, etc.). These co-signers, if they value their careers, must look at the order to make sure it is correct. It certainly is for the pts' saftey.

Not knowing your Exact circumstances, I can't put you *or* the instructor at fault. But as for the generality, you Always check the orders, whether you are giving the med yourself, or are a co-signer.

DC :-)

[elkpark]

I don't have any opinion about failing clinical or not (since I don't know anything else about the situation other than what's posted here), but I definitely would not co-sign with a student of mine for removing a narcotic without seeing the MAR with the narcotic order.

[Stephalump]

I'd think a med error would involve one of the six rights. It sounds like maybe you didn't follow the narcotics procedure laid out by your school/clinical site, but I can't imagine kicking someone out for not having the MAR ready for a cosigner. All that was required was for the instructor to refuse to consign without seeing it and then you going to get it. Failing over that seems unreasonably strict, but I'm also only getting one side of the story, so who knows.

[Compassion_x]

She should have just asked you to pull out the MAR first before signing....wouldn't (and shouldn't) have been that big of a deal. Unless I'm missing something here.

[BostonFNP, APRN]

What's the rest of the story? Something seems to be missing...

I wouldn't sign for you without seeing the MAR, but I surely wouldn't have failed you unless there was more the the story (the MAR didn't back your story, it was the wrong med, etc)

[classicdame, MSN, EdD]

we do not allow nursing students to give narcotics, but in general, the MAR should be present when the medication is taken from Pyxis.

[nursing?s]

Yes, I checked the MAR and then the nurse on duty came and opened it to one of her clients while I was opening the Narc drawer and signing the Narc book. I had checked the front PRN page with the pain assesment and the MAR box to double check the time, and then the Narc book to get the med and triple check the time. The only issue was that I didnt have the MAR out ant ready for my instructor to see.

[nursing?s]

The MAR and then the NARC book. But her issue was me not having the MAR out and ready for her to see. I have done it this way all thru school without correction or complaint, if the nurse/teach would ask then I would get it but they have always said the only thing they were doing is verifying the count.

[nursing?s]

No, we pass all meds, injections, Tx, etc. We only have to have Narcs cosigned, and insulin double checked. We are training to be nurses so they want us to do everything on our own, with supervision of course, so we know what we are doing when we get out there.

[mind_body_soul RN]

Our professors can't obtain or cosign narcs for us, we have to have the primary nurse do it. The nurse or instructor can only cosign meds THEY personally pull for us, and we have to have the MAR in hand for them to verify. MARs have to be checked against the doctor's orders. Or else it is a med error. For any med errors, we get a "RED CARD", a nasty form of shame that we have to fill out in the nursing office at school. I have heard 3 red cards and you're out. However, you can fail the clinical and most definitely the semester, even get kicked out of the program, at their discretion, for any incidence of "unsafe practice", which I guess could include a med error. The only stories I have heard where people actually got kicked out, were because the patient sustained actual and severe bodily harm as direct result of the student's actions or failure to act.

[melmarie23, MSN, RN]

when I was in school, I couldnt remove meds without my CI or the RN I was working with that day. So signing it out of the MAR/doing the NARC book by my lonesome would have been the offense.