One of the nursing facilities where I work has some bad practices when it comes to medications. I've seen patients overmedicated, had nurses lie to me about which medications were being given, had nurses ask me to order meds to "keep the patient quiet", and most recently, saw a PRN antipsychotic medication hand-written into a patient's MAR when there was no order for it (I had recently discontinued the medication because it wasn't being used and the patient was no longer agitated). I've mentioned my concerns to a few of the nursing staff, and it definitely hasn't made me any friends there. I go home feeling sad and angry.
I've thought about making an anonymous complaint about these conditions, but I'm not sure how I would do this, or if I should. I work in MA.
I Googled Massachusetts, ombudsman for skilled nursing facilities. It seems like a good place to start. You may not be able to be anonymous but you need to do the right thing.
Do the right thing, you are a professional and that might be you in the bed one day.
If you have safety concerns about medication administration, please bring them to the attention of someone who can do something about it from a systems perspective, like the DON. I've worked for years in LTC facilities, and have come across errors on a MAR - despite the many steps in place to avoid med errors. I once supervised an NP who was not monitoring INRs though a patient was on warfarin; when it was finally checked, the INR was too high to calculate, and the NP blamed the doctor for ordering the warfarin without INR lab orders. If you're the one signing the MARs each month, you're responsible for what they contain, and you want the orders followed safely.
The actions you take aren't to punish anyone, but to maintain patient safety. Bring documentation and specific examples to the DON's attention, and ask how you can help. Perhaps offer an in-service on non-pharmaceutical management of agitation/dementia. When I've been asked for orders to sedate a patient with a benzo, I use that encounter to educate about risks associated with that prescription, or to figure out what else is happening that may be the cause of the behavior, i.e. UTI. Maintaining open communication and healthy working relationships in nursing facilities is a major part of success at your job, and there's no need to be anonymous when working through safety concerns.
I agree that it would be ideal to go through someone at the facility first. Unfortunately, the times I've tried to bring up issues with the nurses or DON, it did not go well. The staff have become defensive. It's not just this one med issue; it's been a lot of issues. The one time I went to the DON, she snapped at time and told that she didn't have time for it.
Last week, I realized that one of my patients had been off of one of her meds for two weeks (a schizophrenic patient who was without her antipsychotic). When I asked the nurse why she hadn't had her meds for two weeks, she shrugged and said, "I don't know." When I looked shocked, she asked me, "Is that a problem?", and then gave me the stink-eye for the rest of the afternoon. I think I'm seen as making trouble when I ask questions. I hate being in this position.
Do you work with a group/physician and could perhaps schedule time to meet with some allies by your side?
This may sound rather formal, but necessary since the feedback you're getting is not at all productive or
conducive to patient safety. Approach is so important - remember "why" questions tend to bring on defensiveness.
I can't speak for this specific place, but some places have an integrity line that both staff and family can contact/report when things aren't up to snuff. They usually take those reports seriously.
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