coumadin error

I've seen this sort of thing happen in LTC more times than I care to count.......lack of communication between shifts, between management nurses and floor nurses, between facility and doctor etc. is rampant, and unfortunately in this case it may have contributed to a resident's death. I've seen orders for high-alert medications that are illegible, misspelled, or just plain WRONG, and once patients are in the nursing home, it's all too often 'out of sight, out of mind' for a lot of docs, so it becomes difficult, if not impossible, to clarify those orders.

However---that Coumadin order should have been clarified by the very first licensed person to see it, and if nothing else the resident care manager should have been aware of the problem and taken care of it herself. When I was an RCM, I always had admission orders faxed to me before a resident even arrived on my unit, so I could call the MD and get any questions answered before the resident dropped off the physician's radar screen. I caught more than one potential error this way..........once, I had a resident come in with orders for what looked like 100 units of Lantus insulin at bedtime, an amount I thought excessive, so I called the physician. Turned out the order was for 10.0 units.......of course, the doc shouldn't have put that extra 0 there, but at the time I worked with a couple of nurses who WOULDN'T have called to question the order, and thus the resident might have received a tenfold overdose of insulin :stone

Granted, not every LTC facility is so lackadaisical about following up on questionable orders, and certainly no hospital is perfect either; but it's terrible that SOMEONE didn't take the initiative and follow up on that Coumadin order sooner. On the other hand, the nurses involved should NOT write letters admitting their culpability---that's just asking for trouble, and their DON is way out of line in trying to get them to do so. JMHO.

I would never, ever put anything in writing other than a totally objective, actual incident report. If this becomes a lawsuit, the facility will use these "statements" as a means to prove that their "system" was not faulty but instead that the nurses were negligent. They are covering their own butts at the expense of the nurses. In addition, all these "statements" are discoverable in a lawsuit whereas the incident reports are not usually. Not a bad idea to talk to a lawyer and, ideally, a nurse attorney who handles these types of situations.

I've got to tell you that incident reports are discoverable. If the other side of the lawsuit knows that any kind of documentation about an incident exists they can file a request with the judge to get copies of it. It doesn't always mean that they will get to see it, but it has happened that judges have allowed the incident reports to be discovered by the plaintiffs.

I would never write anything on a incident report that I didn't already have in my documentation in the patient's chart anyway. The only other information on an incident report would be statistical data used by the safety committee of the facility.

Don't you have to be 65 to be on medicare?

No. People who are determined disabled by the social security administration are eligible for Medicare and Medicaid benefits. This would include people who have had catastrophic events that have left them unable to work steadily, or people who have chronic mental illness that has prevented them from continuing to work. If someone needs dialysis or is diagnosed with terminal cancer they can apply for and will most likely be made Medicare eligible through disability. Anyone who has a kidney transplant is automatically placed on Medicare for one year. The rules change from time to time and they can be confusing.

I've seen this sort of thing happen in LTC more times than I care to count.......lack of communication between shifts, between management nurses and floor nurses, between facility and doctor etc. is rampant, and unfortunately in this case it may have contributed to a resident's death. I've seen orders for high-alert medications that are illegible, misspelled, or just plain WRONG, and once patients are in the nursing home, it's all too often 'out of sight, out of mind' for a lot of docs, so it becomes difficult, if not impossible, to clarify those orders.

However---that Coumadin order should have been clarified by the very first licensed person to see it, and if nothing else the resident care manager should have been aware of the problem and taken care of it herself. When I was an RCM, I always had admission orders faxed to me before a resident even arrived on my unit, so I could call the MD and get any questions answered before the resident dropped off the physician's radar screen. I caught more than one potential error this way. . .Granted, not every LTC facility is so lackadaisical about following up on questionable orders, and certainly no hospital is perfect either; but it's terrible that SOMEONE didn't take the initiative and follow up on that Coumadin order sooner. On the other hand, the nurses involved should NOT write letters admitting their culpability---that's just asking for trouble, and their DON is way out of line in trying to get them to do so. JMHO.

I would have loved to work with you! The facilities I worked in did the same thing. We knew and had clarified the admission orders before the patient even set foot in the facility. Any questions we had went right back to the doctor or the discharge co-ordinator at the hospital. Those admission charts were given special scrutinization.

I also just wanted to say that the DONs in some of these nursing homes are just RNs like any other RNs. Some of them get their position by luck, because no one else was around to take the job. They take the position because they've always wanted to be in a managing position. When an incident like this comes up it's their initiation by fire into the complex world of management. Nursing homes have very special problems and are more regulated by law than any other healthcare facilities. It's become that way for just this kind of incident happening again and again. Since the nursing homes won't police themselves and clean up these messes, the legislators have had to step in and do it.

Unless the patient's family insists on something being done, this thing is probably going nowhere. Nurses hands will get slapped (or whatever the facility decides to do). Unless a direct cause linking this patient's death with not receiving this medication can be proven any court case will probably go nowhere. I'll bet there are other medical problems this patient had that most likely contributed to what happened as well. This family is going to be lucky if they can get a settlement that will pay the patient's medical expenses (that is, assuming they sue). Isn't that sad?

but marla, you must agree that an incident report and med error report be initiated for all those involved. of course you never say i was negligent,but as i stated, you report the facts only, even if there are repercussions.

leslie

Absolutely! I'm as anal as anyone else about incident reports, and I'll write them even for potential errors that never reach the patient but which COULD have harmed him or her.

What I was referring to was the DON's demand that the involved staff write letters admitting guilt, which is something you NEVER want to do if you wish not to pay through the nose with everything you might ever possess in your natural lifetime. People sue for anything and nothing these days, and sorry to say, if a nurse puts down on paper something that essentially states "I did it, it's my fault", he or she gives up any chance of winning in court. :stone