Hi guys, I work in a alz/dementia assisted living facility. It currently has 52 residents with room for 66. The problem I am having is the other nurses not doing what they are supposed to do, making huge mistakes and it is scaring me to death.
The facility is one building three different locked courts. 1 LVN per shift for the entire building. 6-2 shift has 2 LVN's but the second one is the DRS, she doesn't work the floor.
These are the examples just for the last month.
All a.m. meds are marked on the MARS to be given at 8, how can you be in 3 different courts at once?
Not all meds are being given, I find cups of meds from the previous shift sitting in the top drawer of the med carts, and it's not being charted on the MAR as held or refused. They are signed off as given.
No orders for treatment are even gotten. If you are off of work and someone gets a s/t it stays on the alert charting form for three days. If you are off for 3 days or more you never see it and never know it is there. I have found three residents in the last 2 weeks with bandages that have not been changed in who knows how long. I found them by smell! Why? because no one bothered to get an order and put it on the MAR so everyone would be aware of it.
A resident had an order for Lamisil p.o. x 30 days. who ever copied it to the MAR forgot to put x 30 days. So she got the med for an extra 24 days. I discovered it by accident, because I was doing 30 day order updates to be faxed to M.D. for signatures.
A resident was given Rx for bactrim, I was off for 3 days and when I came back I saw it on the MAR. The problem? The bubble pack for the a.m shift was unopened, but 3 were missing from the p.m buble pack and the order date was from 3 days before. Meaning she did not get her a.m dose of ABT for the first 3 days she was on it.
I noticed a residents Zyprexa pill count was really low. I know when the family delivered the medication and how much was delivered, because it was given to me personally by the family member. I left a note on the MAR asking where is her zyprexa. It turns out the a.m nurse was giving meds by memory not MAR and was giving her zyprexa in the a.m. when resident is only supposed to have it in the p.m. So resident was double dosed for approximately 13 days. When I confronted said nurse she said "oh, just don't give her any for a few days she'll be fine"
I found phone orders from 8-o6 that had never been mailed to M.D. for signature.
I found 30 day orders from as far back as 4- 06 that have never been updated.
I find meds in the cart, usually cough medicine or vitamins that have been brought in by the family for resident use that are not on the MAR and there is no P.O for them and they are being given to the resident.
I found new phone orders for a resident who is now actively dying stating that he is NPO, all meds d/c'd except MS elixar etc..that were written 8 days ago and never transferred to the mar. The staff has been getting him out of bed for meals!
When I left for my 3 days off a resident had exactly four pills of ativan left. I told oncoming shift in writing that the family needed to be contacted for more. When I came back the med had never been ordered and there were exactly four pills left. Meaning that they were never given. This is a standing order.
I keep going to the DRS and she keeps telling me to fix it! I don't want to spend all of my fixing things.
I hate confrontation and because all of the other nurses are experienced and have worked ther for a 1-2 yrs ( I have been there for 4 months) they tend to blow me off. I have threatend to quit several times and my DRS begs me to stay, (guess they need somebody to clean up the mess).
Now mind you, these are just the mistakes I have found in the last thirty days! What do I do to make these people get with the program. I am scared to call the state as I am sure I made a a few mistakes in my first couple of weeks, (mostly charting, somebody forgot to explain to me about charting procedures, I was told that because it is assited living that they don't chart. So I didn't chart for the first 3 weeks I was there.) I am scared of losing my license but I am more scared of what may happen with the residents, I truly care about them and want to do my best to help them, this kind of treatment and uncaring attitude makes me mad!
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