Med Not Available = med error?

  1. I read a while back some posts about putting "med not available" on the med sheet if a med could not be located, and it seemed like this was a generally practiced proceedure for documentation. So, after not being able to locate a patients eyedrop late one night I circled it, and put med not available. Well I was recently reprimanded for this by my nse mgr who said I would be written up as this was an omission of medication. If it is late at night and the med is not there (in an LTC facility with no internal pharmacy), what are you supposed to do????? :uhoh21: I'm certainly not borrowing another patients eyedrop!
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  2. 18 Comments

  3. by   suzanne4
    What is the policy of your facility? Did the nurse manager want a call so that she could to go out and pick some up or did she want you to leave and go to the drug store to get some?

    What was she thinking? :uhoh21:

    I know of a place where people like that should be, and it isn't around patients or anything that lives and breathes..............
  4. by   findingmywayRN
    Suzanne4: I am going have to study the policy manual after this one, but I like the idea of calling her at home :chuckle I guess from now on I'll just call the nsg supervisor to put it in management's hands.
  5. by   Blackcat99
    They want you to "lie" and have you pretend that you actually gave the med. If you don't they have you fill out a medication error report to make you "the bad guy". Most pharmacies will not bring your med at the exact time you actually need it. If the med is not given as ordered the LTC gets in trouble and they get fined by the state. If a nurse refuses to "lie" on the med sheets they may have you fill out a medication error report each time. When they see you are not willing to "lie" they fire you because you have too many "medication error reports". Or some LTC's just ignore you and then when the med sheets go to medical records they forge your initials on the med sheet and cross off the part of your charting on the back of the med sheet that says you didn't give the med.
  6. by   elkpark
    Lots of people in LTC are between a rock and hard place on this, as Blackcat99 noted. The short answer is yes, if the medication is not available and you were not able to give it at the scheduled time, it's a med error. However, not all med errors are the nurse's "fault." If it ain't there, you can't give it!

    Falsification of records is a serious issue, and can get you in lots more trouble than an omitted med. Follow your facility's policies and procedures on med administration scrupulously and document everything accurately, in order to protect yourself as much as possible (although, as Blackcat99 noted, the facility administration can still make your life miserable to cover their own butts). The administration is not going to step up to defend you when it's your license in trouble ...
  7. by   CoffeeRTC
    NOt all med errors are the nurses falult. Our med error form has a space to check pharmacy error. I'll be hones, I've never written one of these up for missing meds....maybe I should (who has time for an extra form)
  8. by   elkpark
    Our med error form has a space to check pharmacy error. I'll be hones, I've never written one of these up for missing meds....maybe I should (who has time for an extra form)
    If it were me, I'd be sure to do this every time it happened -- why should nursing get blamed for pharmacy's problems? If there is a chronic problem with pharmacy supplying what the units need, that needs to be made clear to the higher-ups and addressed. Seems like everyone in healthcare gets a free ride except the nursing staff, but that's because so many of us are willing to put up with it!
  9. by   Dixiedi
    Quote from elkpark
    If it were me, I'd be sure to do this every time it happened -- why should nursing get blamed for pharmacy's problems? If there is a chronic problem with pharmacy supplying what the units need, that needs to be made clear to the higher-ups and addressed. Seems like everyone in healthcare gets a free ride except the nursing staff, but that's because so many of us are willing to put up with it!
    100% agreed! Nurses are so worried about getting written up and/or fired that they will do just about anyting administration tells them to. Ya know what? It really doesn't happen that way, at least not in my experience.
    I have worked LTC on a couple of occassions. I not only made my notes on the medication record, I made them in the nursing notes. That pretty much prevents the facility from changing my records. I also make whatver calls are needed to cover my own butt. It's not my worry if I wake someone up in the middle of the night. Hey, that person is the one who chose to take that job, it's part of their duties! I also follow that up with an incident report. Put the responsibility where it belongs.
    I know that facilities DO INDEED retaliate on those who make waves, but if you do a darn good job of covering your own butt, they don't have a lot of chance to retaliate on you. They are forced to take it where it belongs and that is, in this type of incident, the nurse who failed to reorder routine meds or the pharmacy for not making the scheduled delivery on time.
    Unfortunately it's all about covering your own butt and hopefully you'll have a little luck in the proccess and they won't find a common error that you have made to retaliate against you with. (Like putting your initials in the wrong square on the med sheet! - oh yea, it happens all too easily especially towards the end of the month on a weekly or monthly med.)
  10. by   prmenrs
    Did the NM tell you what to do the next time that situation occurred? If not, go back and ask.

    Also, med error reports, or any other type of incident report are not supposed to be witch hunts any more, they are supposed to be used to find the "broken" part of the system so it can be fixed. At least that's the way I've been told it is supposed to work.
  11. by   Dixiedi
    Quote from prmenrs
    Did the NM tell you what to do the next time that situation occurred? If not, go back and ask.

    Also, med error reports, or any other type of incident report are not supposed to be witch hunts any more, they are supposed to be used to find the "broken" part of the system so it can be fixed. At least that's the way I've been told it is supposed to work.
    Hey, that's what I was told over 30 years ago when I was in school! Reality check... that's usually exactly what they are used for.
  12. by   Destinystar
    call the md or the medical director. ask to get an order to hold the dose. then put in the doctors order and on the mar "hold 9 pm dose of ....." as well as in the nurses notes, report sheet, etc.then you will be just fine. if the med was all that critical it would be in the emergency box for meds.

    working in ltc is a battle of wits. there is only one way to do things and that is the right way. you have to have very sharp problem solving skills to survive in these places. think outside of the box.
  13. by   cannoli
    Quote from destinystar
    call the md or the medical director. ask to get an order to hold the dose. then put in the doctors order and on the mar "hold 9 pm dose of ....." as well as in the nurses notes, report sheet, etc.then you will be just fine. if the med was all that critical it would be in the emergency box for meds.

    working in ltc is a battle of wits. there is only one way to do things and that is the right way. you have to have very sharp problem solving skills to survive in these places. think outside of the box.
    what do you then do if they won't give you an order to hold the dose?
  14. by   Dixiedi
    Quote from cannoli
    What do you then do if they won't give you an order to hold the dose?
    Most of the docs will give just about any order the nurse asks for. I've never had a doc in LTC or home care (matter of fact don't remember ever being turned down in acute care or corrections either) turn down an order i've requested.

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