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

Specialties LTC Directors

Published

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.

Specializes in LTC.
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.

I write the date, time, Med order, (Ex.. Remeron 15mg).. not available, faxed to *pharmacy's name*

Ex

12/9.. 9pm.. Remeron 15mg not available. Faxed to *pharmacy*

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Specializes in Nephrology, Cardiology, ER, ICU.

Okay folks lets settle down!

If you wish to have a discussion only between two posters, use the private messaging system please.

Also, if there is something objectionable, report it, don't engage.

There is also an ignore feature.

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"Borrowing" meds from another resident is wrong so I can see why she was upset when the trainer did it, but at the same time, if you take the time to go through all the steps (circling with explanation, calling pharmacy, writing incident report, calling the doctor for one time hold order, etc.) you'd be there all day and night and never give out a single medication. Well, I'm exaggerating, of course, but that is the way it is where I work. There are at least five or six residents out of meds every time I work. I don't even have time to give out all the meds I have to give out much less carry out all the aforementioned steps when that happens.

At one nursing home I worked, one nurse was responsible for reordering (on nights) and that really worked out the best. When everyone is responsible for pulling the little paper on the med card when it should be reordered, then no one is responsible and it is too easy to just skip it.

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Specializes in LTC.
Sad to say I am glad someone is in the "real world" with me. We have to care for our patients.. not call the state and the ombudsman because we have to take x amount of insulin from someone elses vial.

Coumadin is a big borrower in our facility. I could go on and on about this. The doses are changed if needed after the results of the PT/INR gets in and we don't have the dose in from pharmacy yet as this is done in the early afternoon. 3.5 is the dose that I can never find. I couldn't find any 2.5s either. So I had to take a 3. Cut it in half to get a 1.5(It was scored). And hunt down a 2 mg.

ARGH I totally know what you mean. My first job I used to wish we had a special coumadin e-box (only not locked up and requiring paperwork)!:lol2:

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Specializes in LTC.
ARGH I totally know what you mean. My first job I used to wish we had a special coumadin e-box (only not locked up and requiring paperwork)!:lol2:

...and with Vitamin K in it. Not completely sure if we have it in the e-box(we don't have coumadin) but thank god we had leftover vitamin k that wasn't sent back from a resident who was discharged .. when we had to give it to a resident with a high INR.

Pharmacy seems to be slow as donkeys these days.

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Specializes in LTC, Hospice, Case Management.

I couldn't get your medicare link to work to see what you are referring to but try looking up info on the perspective payment system for Medicare A residents in long term care. The facility is NOT getting reimbursement for each individual medication given to a resident. Doesn't matter is they receive only one aspirin in a 30 day period or IV micofungin (insanely expensive ABT for fungal infection)...the facility will still be paid based on the MDS RUG score. This is why your MDS nurse drives you nuts with demanding perfect documentation.

If a medication is not available the nurse should attempt to get pharmacy to deliver is ASAP, obtain it from the EDK if available and if the medication is still unable to be obtained the MD must be called & requested to order an alternative medication or permission to hold until medication available. It is never acceptable to just sign off on back of MAR that med is not available.

To the OP...unfortunately I think you are getting a negative reaction from your supervisior due to your negative reaction to the entire situation. You made a mountain out of a molehill & completely bypassed the chain of command to work on fixing your concern. That rarely sits well with management.

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Whoa, whoa, whoa!

The residents need their meds.

The nurses should be ordering meds on time.

Meds are being "borrowed" to take care of the residents.

There's a system problem here, and, while this is illegal, it is far from criminal in the way you are using it. Start getting meds ordered on time.

STOP! This is a crime & a guarenteed way to loose your licence!! Don't EVER "borrow" medication from another resident, among the many charges would be practicing as a pharmacist without a licence & there is serious fines & jail time!

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Yes. They are not good.

Oh my lucky day - our facility just switched to Pharmarica

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STOP! This is a crime & a guarenteed way to loose your licence!! Don't EVER "borrow" medication from another resident, among the many charges would be practicing as a pharmacist without a licence & there is serious fines & jail time!

Well, I guess everyone is going to jail. :lol2:

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Specializes in ICU, CM, Geriatrics, Management.
Well, I guess everyone is going to jail. :lol2:

No way there's room for everybody!

Oh wait. Forgot Casey Anthony's cell will soon be available for someone in FL.

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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"................:uhoh3:

WOW, ok as a DNS, this is the issue. ALL Nurses, on ALL shifts are responsible, period for reordering ALL meds (not just the meds they give on their shift). The same is true of the e-kit, which is counted every 8 hours, so if you see the red tags, know the ekit has been opened, and still see the white sheet there, pull it out, fax it and follow-up with phone call to pharmacy, until you get that replacement ekit. Go to the other floors for ekit if needed, we have 3 ekits, on 3 units, many, many opportunities to find meds. Re: Coumadin: have your DNS/DON tell pharmacy they want all the mg of coumadin, ie 1 mg, 2 etc so can meet most used doses, and make sure as the DNS, it happens (you are required to hold the DNS accountable just like the DNS is to hold you accountable). I love to get written suggestions from staff, I love that they care enough to tell me stuff.

Unit manager should be consulted immediately, and systems re-activated and nurses retrained. There is NO borrowing, not for any reason. ALL pharmacies can satellite all meds, and if not, again, go to DNS who will now hold her pharmacy accountable (I have the pharmacy head on speed dial and email, he responds within one hour if I email him my issue and med usually shows up about an hour after that).

As a nurse, it is OUR job to be a competent nurse, we know what is right and wrong, I have to know to order the missing meds, ekit, and I know to report these nurses to the management team of the facility.. LTC is evolving and I do not tolerate "old" behavior, and why should any of us? Walgreens will send over any med I need, if it is 0200 or a Sunday, I call the on-call pharmacist, wake him/her up until I get my med, period. And I tell the MD when I can't get a med, as well as the family and the resident, and sometimes the med isn't that necessary and the resident can go "without" or "hold until new dose arrives" there are a variety of MD orders you can ask for. MD will often write order for a med in e-kit say out of Morphine 15 mg, need signed Schedule 2 script at pharmacy, it's a Sunday, MD out of town, the MD can give T.O to administer Oxycodone 15 mg po UNTIL MS comes in, MD calls into pharmacy, there's your auth to pull the other narcotic. YEah, its a bit of paperwork, but the pain is addressed, there is no squablling between nurses, and pharmacy is on notice to make sure that Morphine gets sent out, as soon as MD give signed schedule 2 script.

I think it is a real shame that nurses let other nurses sway them away from what we all know is right. Yes, when I was a new nurse, and I orientated, I saw ridiculous things, (i saw plenty of silly things as a C.N.A as well) and as soon as I was on my own, on a med cart, I did it the right way. I personally re-ordered all the meds, way before they are due, and I did this as a Resident Care Manager, once per week, asked the nurse to let me have the cart for 5 minutes, pulled off all stickers with 8 meds or less, faxed to pharmacy, problem solved.As a CNA I watched countless nurses bicker over narcotic count, said one day "Look, you all have been counting for an hour, you can't figure out the liquid, sign it as count incorrect, call the DNS, you go home and you pass your meds, end of story". Both nurses were so shocked a CNA would say that, they actually followed my directions, and of course, the DNS asked to speak to me what I had seen. Did those nurse like me? Absolutely not and absolutely sometimes yes, but my real concern is good resident care, not a popularity contest. If we don't stand up, who will take care of the residents properly? We need leadership in LTC, not followers who fail to function.

Sorry if this sounds preachy, just hits a nerve with me. There is no excuse for bad behavior, doesn't matter how many are misbehaving. Are we receiving a paycheck for being a nurse? then I expect the nurse to act as a nurse, period.

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