Given another patient's medication to satisfy MAR.What do you do? Orientee

[rn_nxt_dr]

On my 2nd week of orientation, I saw this happen under 3 different nurses.

The patient's medication packet was empty and the trainer pulled the drug from another patient's medication packet to satisfy the MAR; because as we all say, if it's not documented, it was not done.

The 4th incident was a patient's NPH, no NPH bottle, and the 4th nurse said to me, "I know this is wrong but this is how you do it, take this NPH (another patient's NPH) and draw what you need." I refused and asked for the emergency kit, and it was also empty.

What would you do? Where to report other than LTC Ombudsman? This is criminal and they have to be punished.

[NurseKatie08, MSN]

On my 2nd week of orientation, I saw this happen under 3 different nurses.

The patient's medication packet was empty and the trainer pulled the drug from another patient's medication packet to satisfy the MAR; because as we all say, if it's not documented, it was not done.

The 4th incident was a patient's NPH, no NPH bottle, and the 4th nurse said to me, "I know this is wrong but this is how you do it, take this NPH (another patient's NPH) and draw what you need." I refused and asked for the emergency kit, and it was also empty.

What would you do? Where to report other than LTC Ombudsman? This is criminal and they have to be punished.

oh boy :icon_roll

[rn_nxt_dr]

Thanks for all your rseponses.

I did raise the issue with the DON---after the third incident, she told me about the E-kit, which was hardly full, even NPH back-up is not available.

I was told that I will be moving to another position (unnamed), my schedule was re-arranged, I was suddenly asked to not show up on a scheduled work bec. of a new schedule and to call the DON and clarify and I never heard back again.

So, this is LTC? When your own supervisor treat you like a piece of ---- and was just brushed off for raising a relevant issue that may affect patients, much less hurt them?

I called the Ombudsman and expressed my concerns, the rep said that it's a common thing in LTC---they got to do what they got to do. So, I just dropped the idea because they too didn't do anything.

So, this is nursing? I hope to get this to the residents' families and get it to the public to give these nursing homes a boot!

It's an outrage that this is happening---simple procedural drug supply can't even be met. I am truly disappointed.

If there's a DON out there reading this....why do you do what you do and how do you address this?

It may sound simple but this is a violation nonetheless. And these nurses training me who have the audacity to say ----"I know this is wrong but this is what you should do"................

[CapeCodMermaid, RN]

You called the Ombudsman??? What for? They are not pro anything really...you'd have done better by continually calling the pharmacy.

[Thor77]

In our facility it is the 11-7 shifts job to reorder all open e-kits on a daily basis. This way if you are missing something like an insulin or a coumadin dose the kits are always fully stocked. Also we only have 1mg tabs in the coumadin kit. having 11-7 take over this responsibility have greatly reduced the frustration of not having a med. We also use Pharmerica and we have had our share of "plan of correction" meetings with them

[anonymous1919, LPN]

Thanks for all your rseponses.

I did raise the issue with the DON---after the third incident, she told me about the E-kit, which was hardly full, even NPH back-up is not available.

I was told that I will be moving to another position (unnamed), my schedule was re-arranged, I was suddenly asked to not show up on a scheduled work bec. of a new schedule and to call the DON and clarify and I never heard back again.

So, this is LTC? When your own supervisor treat you like a piece of ---- and was just brushed off for raising a relevant issue that may affect patients, much less hurt them?

I called the Ombudsman and expressed my concerns, the rep said that it's a common thing in LTC---they got to do what they got to do. So, I just dropped the idea because they too didn't do anything.

So, this is nursing? I hope to get this to the residents' families and get it to the public to give these nursing homes a boot!

It's an outrage that this is happening---simple procedural drug supply can't even be met. I am truly disappointed.

If there's a DON out there reading this....why do you do what you do and how do you address this?

It may sound simple but this is a violation nonetheless. And these nurses training me who have the audacity to say ----"I know this is wrong but this is what you should do"................

Yes this is "real world" nursing. It's not perfect, and it doesn't matter whether you are in LTC or A Big Name Hospital. If you can't cope with that fact get out of nursing. Calling the Ombudsman did what exactly for you? Nothing. You should have called Pharmacy and had the medications stat ordered. If you feel more comfortable letting your patient go with out their lisinopril, lasix, dig, etc.. fine.. circle the med and move on, I guess. Me, personally, I'm doing whatever I can to make sure my patients have what they need.

Again, welcome to the real world.

[Havin' A Party!, ASN, RN]

I wouldn't report it to state or ombudsman. Go to your director of nursing with your concerns first and foremost. Obviously the policy on nursing's role in reordering meds needs to be reiterated. Or maybe it's not nursing maybe the pharmacy needs to be updated on the delivery problems. We are strict about not "borrowing" meds in our facility. If the pt is out we try to get it from the E-kit. If that med is not in the E-kit we call the pharmacy and ask for a stat delivery.[/quote']

Excellent response, P.

[Havin' A Party!, ASN, RN]

... Employers like employees who take action when they see that something needs to be done.

Agree that's the right thinking.

From experience, I have to relate not all employers share this view. Some bosses are very territorial, and insecure. As a result, they sometimes see an employee's action as crossing over onto their (the boss's) turf. Most unfortunate.

[Butterfliesnroses]

You shouldn't be so surprised that you were let go...You are makng a mountain out of a molehill...rather than complaining you should have FIXED the problem by ordering the meds right away!

[debRN0417]

Very sad to hear you were treated that way.

[indigonurse]

This is a serious medicare fraud issue. I will tell you why. Medicare gets charged for the res. medication. If the facility charges res. A medicare for lasix, but gives it to res. B that is medicare fraud. It is also a violation of a res. rights to steal their medication to give to another, not to mention theft is against most company policies and the law. It is also a violation of the nursing practice act in that a person is negligent not to be following the 5 R's as in checking a prescription label to make sure they are admin. to the Right resident.

The correct thing to do if a resident is out of medication is to see if the med. is in the ER kit and to call the pharmacy to reorder the medication. The MD also has to be called and informed that the med. is not on hand and get a one time order to start the dose as soon as it arrives. The next thing is an incident report needs to be filled out and given to whoever is responsible for reviewing them. The priority and the nurses responsibility is to take care of the resident first. If you call the facilities licensing on them the first person that will be investigated is the nurse who was responsible for taking care of the residents, to see what was done to correct the situation.

[CapeCodMermaid, RN]

It's NOT medicare fraud. The facility pays for all the medication for the medicare residents. Get your facts straight.

[Havin' A Party!, ASN, RN]

Follow-up question:

After circling your initials, what do you write on the MAR (comment section) when the med wasn't delivered / isn't available in the emergency box?

Curious about each facility's practice. Thanks.