Could I lose my license?

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Specializes in Long Term Care.

With everything going on in the nursing world as far as the legal aspects, I'm constantly paranoid about losing my license. Especially working in a long term care facility. As most nurses do, I still feel like I often don't know enough to perform my job as an nurse, although I continue to prove myself wrong. Recently, I had a patient who was taking Keppra. I was preparing to give it to her one night, but when I opened the EMR, I saw that it was not showing to be given. I then opened up the order, and saw that she was only receiving it for 30 days, and that the last dose had been given that morning. After that, I didn't think anything of it. A week later, I just found out that she's in the hospital and had a grand mal seizure. The nurse also said the patient had been behaving peculiarly. The scary thing about being an agency nurse and going to different facilities is that we don't know patients baselines and normal behaviors. The nurse who gave me report said that she declined quickly & that she's heard the family might sue. also, the hospital is blaming our facility for this. The nurse let me know that the person who d/c'd the order should have ensured some sort of test was ordered for the patient after completing the keppra. Please don't judge  me, but I honestly didn't know this, and didn't even think to look for an order for some type of test.  Could we get in trouble for this? Could I somehow be responsible although I didn't give the last dose or d/c the order?

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Specializes in Mental Health, Gerontology, Palliative.

If a medication is only charted for Q30days you cant keep giving it

The doctor needs to front up and own their actions. 

In an ideal world there shouldn't be any repercussions for you. The person who discontinued the order was the doctor. If they wanted tests they should have put the order in

So calm down, take a deep breath

If anyone wants to have a sit down with you, don't do it without a union rep or lawyer. The facility is not your friend and they will throw anyone under the bus if it takes the pressure off them

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Specializes in Long Term Care.
Tenebrae said:

If a medication is only charted for Q30days you cant keep giving it

The doctor needs to front up and own their actions. 

In an ideal world there shouldn't be any repercussions for you. The person who discontinued the order was the doctor. If they wanted tests they should have put the order in

So calm down, take a deep breath

If anyone wants to have a sit down with you, don't do it without a union rep or lawyer. The facility is not your friend and they will throw anyone under the bus if it takes the pressure off them

Thank you for this, I said the same exact thing when the nurse gave me report!! It was the MDs responsibility to order any appropriate testing! Again, I appreciate this feedback. 

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Long term care is a hard gig! You were doing what was ordered, and you don't have the time to look into why every medication falls off your EMR. It is more likely that the MD would be the one to face any consequences, but there's always the chance that you could be dragged into it. I think it's VERY unlikely that anything would come of it for you, but it could still be a pain depending on how the family proceeds. You didn't do anything wrong. If you had called the MD to question it, you were more likely to get flack for calling about a non-emergent issue than you would have been to get something done. Sorry you're in this situation but I really don't think your license is in jeopardy at all. 

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Agree with JBMmom, chance of BON action low.

Since you work agency at various SNF's, it is in your best interest to have nursing , often cost less than $200/yr for bedside nurse ---coverage provides you with representation before board of nursing in this type of situation.  Since lawsuits/ board of nursing complaints can occur years after incident,  may want to jot down a few details of incident now as reminder and don't discuss with anyone.  

Reviewing situation: automatic 30 day stop orders in SNF are risky, especially involving cardiac and anticonvulsants.  What is this facilities policy for verifing stop orders?  Did you report to oncoming shift absence of med renewal + med not given, any chart notation??. Is there a daily communication log to list meds/ issues requiring refill review -- often day shift responsible to make PCP call. Is there an EMR used that pharmacist involved in reviewing stopped orders?   All these steps involved in any medication incident review that I can think of from my time 25yrs ago doing SNF agency staffing -- which I stopped after alone with 50 ambulatory patients to pass meds on one night. 

Multiple people involved in this process, just not you, so don't beat yourself up but use to plan what you would possibly do differently next time.

HUG.

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