Diversion versus charting error

[NeedamiracleADN]

I have a current similar experience, my current employer who I have been with for almost 2 years has pulled me in to accuse me of "diversion". I want to make it clear that it is NOT a medication waste issue or pulling medications without an MD order, the issue they are stating are things like I pulled a medication and in my documentation it states "pt sleeping" but then I woke pt to medicate them. Another example, I pulled 2 medications while at the same time and then administered those medications to the correct patients but I had pulled them simultaneously. Another example, I medicated a pt at 0100 and they were discharged 4 minhtes later. I had medicated this patient for another nurse and yes I chatted that I medicated but because a pain assessment was not done and because the patient was discharged 4 minutes later, they are flagging this. Another "error" was I went to pull a toradol on a patient but realized this was not ordered to I cancelled the removal but the pharmacy states there was no recon of the med, mind you that slot in the drawer is 1 out of 20 that are freely open and anyone can pull from at any time. For example, they can pull a Tylenol but three drawer over is a Motrin and pull that also. They are not individually dispensed like controlled substances. I feel like because I made some charting errors they are now putting a magnification glass on every thing I have done. I consider my charting good, I have seen many many nurse that chart one thing on a patient the entire time, or not until 3 hours after the patient was in their care. I have never been told my charting was not sufficient enough, until this very moment. I have tried to give my reasoning and explanations to the examples they are giving but now I have to give a "response" in writing and then they will make their decision regarding my employment status. I feel like they have already made their decision and I'm just prolonging this nightmare. I am a mess, I just cry and I haven't eaten in days. What do I put In this "response" letter to change their minds and give me another chance to redeem myself?

[OyWithThePoodles, RN]

Do you have barcode scanning medication administration? If so the "pt sleeping" incident should show that the med was given. If not and you charted that the patient was sleeping, but say you gave it...looks fishy. You should've undocumented that the pt was sleeping if you woke them up and they took that medicine.

The pt that was discharged 4 minutes after medication was given, again, if you scanned it, you should be able to prove that it was given. You should always do a pain assessment prior to medication being given and some facilities may call this an error if it wasn't done. As far as the re-assessment, you couldn't do that because the patient wasn't there. I will add, most facilities that a policy that you have to wait 30 minutes to an hour after pain medication is given to discharge the patient, I would look into your facility policy.

The toradol: How can you pull a med that wasn't ordered on a patient? You would have to have rights to override in order to "click" it on the pyxis screen to get the drawer to open.

I wish you the best of luck, but it sounds like they have your number and I would start looking for another job.

[JKL33]

If not and you charted that the patient was sleeping, but say you gave it...looks fishy. You should've undocumented that the pt was sleeping if you woke them up and they took that medicine.

Nah, none of it "looks fishy," but rather these are a combination of things that happen in a frenzied environment; actions by people (nurses) who are trying their best to keep up and it doesn't dawn on them what their actions may look like from the outside when those with nefarious intentions twist them. From the post in the General forum, they refused to do a UDS and are simply bullying this nurse; calling this "diversion" while saying that they aren't saying that s/he actually took (stole/diverted) the meds.

Unbelievable. The particulars of this type of treatment aren't justifiable.