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.

[Multicollinearity, BSN, RN]

I know this is an old thread, but I found this during a forum search regarding "borrowing" other patients' medication when out. I recently worked with an RN whose license was suspended for doing this in an LTC environment. No harm came to the patient related to her action. The issue came to light when the patient died and the family sued for reasons unrelated to the medication issue. Due to the lawsuit the BON and medical board were notified, and the medication issue was discovered.

I read her disciplinary order on the BON's website. There were no other issues, just taking a medication from a discharged patient's supply because pharmacy wouldn't respond, and she didn't want her patient to miss the ordered medication. She gave the med this way for about two weeks because she couldn't get the medication in. She said it was a common practice at that facility. She said the DON was aware of the pharmacy issues, and the place was chaotic. Her license was suspended for one year, and she can only regain it in a year after taking quite a few CEUs related to medication administration. If her license is reinstated after a year she has to inform employers about the action, and the employer has to submit quarterly reports to the BON about her practice. She was suicidal for a while.

[Simba&NalasMom, LPN]

I know this is an old thread, but I found this during a forum search regarding "borrowing" other patients' medication when out. I recently worked with an RN whose license was suspended for doing this in an LTC environment. No harm came to the patient related to her action. The issue came to light when the patient died and the family sued for reasons unrelated to the medication issue. Due to the lawsuit the BON and medical board were notified, and the medication issue was discovered.

I read her disciplinary order on the BON's website. There were no other issues, just taking a medication from a discharged patient's supply because pharmacy wouldn't respond, and she didn't want her patient to miss the ordered medication. She gave the med this way for about two weeks because she couldn't get the medication in. She said it was a common practice at that facility. She said the DON was aware of the pharmacy issues, and the place was chaotic. Her license was suspended for one year, and she can only regain it in a year after taking quite a few CEUs related to medication administration. If her license is reinstated after a year she has to inform employers about the action, and the employer has to submit quarterly reports to the BON about her practice. She was suicidal for a while.

For pity's sake...I'd be suicidal too.

[Blackcat99]

Yup. Blame it on the nurse. Pharmacies screw up all the time and refuse to send the needed medications. Or pharmacy will say "We already sent it" When you explain to the pharmacy that you can't find it they say "tough luck". Keep looking for it.

[amoLucia]

But she was 'borrowing' for 2 weeks! The issue should have been resolved before then. The system broke down somewhere and the nurse got thrown under the bus again. So sad.

[txredheadnurse, BSN, RN]

This is probably going to be a very unpopular response but if the "system" brokedown that badly that a medication wasn't available for two weeks why did the nurse mentioned above continue to shoulder the burden of supplying that med in a non appropriate fashion? Why wasn't the issue explored with the pharmacy manager, the DON and physician notified, if necessary notify/complain to someone higher up the food chain if the in house nursing management failed to resolve the issue? There is a time to remember to not deliberately, willingly, repeatedly do things that are out of compliance or that one can't defend as actions that "....a reasonable and prudent nurse will follow..." because ultimately the nurse is held accountable.

Sometimes one has to be the squeaky wheel and keep insisting that a problem be addressed. Borrowing a deceased patient's medication for two weeks can not ever be defended as an appropriate or professional decision.

[Nursewendy2000]

Had my patient's med sent to another facility...yep, it happens. I try to get the meds reordered the first day it's permitted. That said, if the cupboard is bare I'll do what I have to... Borrowing isn't stealing if the med is replaced. Let me add that I've worked hard to develop a rapport with the pharmacy staff...if I need something fast, they'll bring it.

[BrandonLPN, LPN]

There's no excuse for borrowing for two weeks. It should have been resolved one way or another. But any nurse who says borrowing is "stealing" and the nurse doing so is a "criminal" is being very melodramatic and is going to be quite unpopular with her fellow nurses who she SHOULD be watching out for and supporting.

[HelenaHandbasket]

Ahh I miss having that "new grad" optimism of perfect world nursing.

Anyway, wouldn't everyone agree that one of the largest problems not just in healthcare, but in society in general, is this idea that "someone else will/did/should do it"?

I worked days in a busy sub-acute facility. Technically speaking, it was nights job to pull med reorder stickers. I've worked nights as a nurse and as a sup. Night nursing in a sub-acute is similar to a hospital in that the pace doesn't change much, there is simply less ancillary staff to help out.

On my first med pass in the morning, I'd grab a med reorder sheet and put in on my cart. BFD, so I pull some stickers that either got missed or plainly weren't done. For every med order that was changed, we'd fax a change order. Our policy was that when we faxed a sheet, we'd print the fax confirmation, put our initials on it and put it in a med order book. If there was any question of whether a sheet was sent, we had proof. I never assumed that my team mates were lazy and just didn't do it. I rarely assume the worst about anyone. I figure they had a busy night and didn't get to it.

As far as borrowing meds, I echo others who say, "welcome to the real world of nursing". How many times have we been short supplies? Diapers? Linens? Dressing supplies? Who hasn't taken a 4x4 and cut it in half and folded it to make a 2x2 to fit a wound? What do we do when we are short-staffed?! Refuse to work until the scheduled amount of CNAs show for the shift?

Critical thinking is a huge part of being a nurse. Being able to prioritize. Do you believe that every nurse in a MASH unit, or on a helicopter have every supply they could possibly need for the perfect execution of every procedure? How many MDS Coordinators have had to fill in empty flow sheets in order to complete their assessments? How many Care Planners have run around when the State walks in the door completing care plans for recent admissions?

I always do my best to do everything I can to the ideal, sometimes, it just isn't going to happen the way it "should". Throwing other nurses under the bus does nothing to support the team.

I will NEVER deprive my insulin dependent diabetic patient of necessary insulin and I will defend my action to "borrow", "steal" whatever you want to call it to any board of nursing or court. I also will not leave them waiting for said insulin while I stop my med pass to call the doctor to let him/her know that we don't have any insulin for the patient or wait for the pharmacy to get to the facility with a stat delivery. Then have to call the MDs and family members of all the residents who got their meds late. Not to mention, if I even called the MD to tell them that we had no insulin for the patient they'd be like, "*****! you don't have ANY multi-dose vials of NPH in the building that you could "borrow" from?? You called me at 6a for THIS?!?". Ay carumba! I would get a reaming from the Dr, my DON would get a reaming, my Administrator would get a reaming, and that MD would stop referring patients to our facility for lack of confidence.

[Simba&NalasMom, LPN]

Ahh I miss having that "new grad" optimism of perfect world nursing.

Anyway, wouldn't everyone agree that one of the largest problems not just in healthcare, but in society in general, is this idea that "someone else will/did/should do it"?

I worked days in a busy sub-acute facility. Technically speaking, it was nights job to pull med reorder stickers. I've worked nights as a nurse and as a sup. Night nursing in a sub-acute is similar to a hospital in that the pace doesn't change much, there is simply less ancillary staff to help out.

On my first med pass in the morning, I'd grab a med reorder sheet and put in on my cart. BFD, so I pull some stickers that either got missed or plainly weren't done. For every med order that was changed, we'd fax a change order. Our policy was that when we faxed a sheet, we'd print the fax confirmation, put our initials on it and put it in a med order book. If there was any question of whether a sheet was sent, we had proof. I never assumed that my team mates were lazy and just didn't do it. I rarely assume the worst about anyone. I figure they had a busy night and didn't get to it.

As far as borrowing meds, I echo others who say, "welcome to the real world of nursing". How many times have we been short supplies? Diapers? Linens? Dressing supplies? Who hasn't taken a 4x4 and cut it in half and folded it to make a 2x2 to fit a wound? What do we do when we are short-staffed?! Refuse to work until the scheduled amount of CNAs show for the shift?

Critical thinking is a huge part of being a nurse. Being able to prioritize. Do you believe that every nurse in a MASH unit, or on a helicopter have every supply they could possibly need for the perfect execution of every procedure? How many MDS Coordinators have had to fill in empty flow sheets in order to complete their assessments? How many Care Planners have run around when the State walks in the door completing care plans for recent admissions?

I always do my best to do everything I can to the ideal, sometimes, it just isn't going to happen the way it "should". Throwing other nurses under the bus does nothing to support the team.

I will NEVER deprive my insulin dependent diabetic patient of necessary insulin and I will defend my action to "borrow", "steal" whatever you want to call it to any board of nursing or court. I also will not leave them waiting for said insulin while I stop my med pass to call the doctor to let him/her know that we don't have any insulin for the patient or wait for the pharmacy to get to the facility with a stat delivery. Then have to call the MDs and family members of all the residents who got their meds late. Not to mention, if I even called the MD to tell them that we had no insulin for the patient they'd be like, "*****! you don't have ANY multi-dose vials of NPH in the building that you could "borrow" from?? You called me at 6a for THIS?!?". Ay carumba! I would get a reaming from the Dr, my DON would get a reaming, my Administrator would get a reaming, and that MD would stop referring patients to our facility for lack of confidence.

Well said!!

[Not_A_Hat_Person, RN]

When I worked in assisted living, borrowing was common. I didn't like it, and kept careful records of what was borrowed from whom. I refused to borrow narcs.

The charge nurse in another building was constantly asking to borrow Fentanyl patches for her residents. I only did it if she came to my building and signed out the patches herself. She can risk her own license.

[BrandonLPN, LPN]

When I worked in assisted living, borrowing was common. I didn't like it, and kept careful records of what was borrowed from whom. I refused to borrow narcs.The charge nurse in another building was constantly asking to borrow Fentanyl patches for her residents. I only did it if she came to my building and signed out the patches herself. She can risk her own license.

How on earth was she risking her license? As long as it was the correct dose fentanyl patch and she was giving it as ordered, why would the BON care? What the BON WOULD care about would be if a nurse had a pt with chronic pain

who didn't receive their pain patch as ordered. If a facility does not supply said patch it is squarely the facility's fault, not the nurse's.

With that said, of course she should sign it out herself, after all she's the one who's going to administer it.

[gypsywind]

Medication Error Incident Report - d/t omission r/t pharmacy.. How do we give a med that is not on hand? This is common problem in sub-acute with no onsite pharmacy; medications change frequently and the MAR must reflect that the nurse gave the right med at the right time... we know the drill. When the meds were not on-hand, where I worked at one the "best" sub-acute facilities, we were told we would get a write-up for borrowing and/or omission, even when we circle & write not available notified PCP! Most of the time it was traced back to pharmacy not communicating with nursing. Time & energy is spent tracking the medication, calling the doctor, and calling the pharmacy because faxing 3 times hasn't worked.

After the new "memo" that we must give these invisible meds or risk a write-up, I decided to fire back at the pharmacy. Put blame where blame is due. Why in the world should I or my peers risk a write up, a job loss, or a visit to the BON because pharmacy stated they never got the order but did order the rest of the meds on the same order or the classic, you never ordered the med (most often not true with documentation to back up the pharmacy lie)! The list is way too long for this post of the reasons why we don't have the med, but somehow nursing is always blamed for not giving it, even if it was ordered 3 times in the last 24 hours.

In my anger with the new policy, I actually got a bunch of nurses at the facility to join forces with me and we went on a medication error rampage writing up the pharmacy every time a med was ordered and not sent. Even the supervisor smiled when I told her I will write up the pharmacy. In less than a week, 5-20 medication error reports were filed each shift on all 4 units. Now administration was caught in their own policy!

It played out perfect. Pharmacy called administration and stated that we needed to stop writing medication errors by omission on them, administration rolled it down to nursing, nursing refused to stop because it was our legal right and responsibility to write a medication error incident report for d/t omission r/t the pharmacy. A medication error incident report requires PCP notification, the doc always knew when the pt did not get their meds. Sometimes a stock med was used in replacement. Also,critical meds were then ordered stat by the PCP, adding $$$ to pharmacy's bottom line. By no means did our pt.'s suffer.

Administration quickly realized that they finally lost a battle with nursing. We work short, we get mandated, we get verbally abused by pts & families, we can't stay on the clock to chart (I did anyway) but do NOT threaten us with disciplinary measures when pharmacy is not doing their job! We wrote lots and lots of medication error incident reports, they were not going away just because "they" said to stop.

By the end of the second week administration had no other recourse but to go back to the pharmacy and tell them they will communicate with nursing when a medication was not sent - for any reason. That if they missed an order, they will delivery the medication within 2 hours, no matter the time of day or night. If they are out of stock for a critical med, they will sub contract with a drug store pharmacy and the facility will have the med on hand. And of course they will not send us expired meds. Yes, we had immunosuppressants sent that were expired for a transplant pt.

At the end of the day nursing won this round with administration and pharmacy. Administration called breach of contract and threatened to terminate. Pharmacy stepped up and we started getting all of our meds in a timely manner. Nursing was not blamed for circling the med and writing omission, med not on hand, see medication error incident report on the back of the MAR.

Medication error incident reports took a lot of time out of our already too busy of a day. However I have to admit, it felt empowering to write up the pharmacy for a medication error that admin wanted to blame on nursing!