New order came in for pt at 1300. Nurse put the order in the MAR but did not arrange for stat delivery. Overnight nurse didn't pass info onto day charge nurse. 0800 med was not passed and not in stock. Pt suffered a seizure. Charge nurse, in front of five witnesses said the pts seizure was most likely because of the missed am dose, which made absolutely no sense and made me feel guilty and it caused others to doubt my professional ability.
Two days later charge nurse decides to write me up for the missed dose and completely lies saying she never said the missed med most likely caused the seizure. Said she would never say such a thing.
What should my recourse be. I feel targeted and bullied.
I'm guessing you were the day nurse for this patient the day after said medication was ordered.
What did you do when you realized you didn't have the medication?
If you followed through to the best of your ability with pharmacy, then I would guess you're in the clear.
If you did not, you can be held responsible insofar as any nurse who didn't follow up on an unavailable med could be.
Yes, the nurse who took the order initially should have put in a stat order. Yes, the night nurse who came in next should have followed up on it. None of that necessarily absolves you (or anyone else in a similar situation) of responsibility.
I agree with Brandon. And always chart that you called pharmacy, their response, etc.
The charge nurse's verbal statement that the missed med resulted in a seizure has not one thing to do with your situation; it seems that you are focusing on that in order to deflect from your role in the mishap. The fact remains that there was a problem with the implementation of the order given for the med. Where you fell in that chain of events still is unclear to me, but obviously this needed to be written up in order to evaluate and fix the process that resulted in a missed med. At my facility, all personnel involved who could have made a difference between the patient receiving the med and missing the med would have been written up, not as a punitive measure, but in order to evaluate how things could be done differently in the future to avoid such an outcome.
Missed doses of anti-epileptics are among the biggest cause of breakthrough seizures in people who are generally well controlled. I don't understand how you're being bullied, you didn't give the med and the patient suffered a consequence of this omission. The situation needs to be written up so it can be looked at. If the patient's discharge ends up being delayed because of the seizure and the omitted med was the likely trigger, there will likely be some sort of financial hit to the hospital.
It sounds like the OP works in LTC. The only recourse to unavailable meds is to get them from pharmacy.
Where I worked, the pharmacy was out of town and only delivered once a day. Missing a med for a day was not unusual.
No right, but not unusual.
My thought is that the nurse who didn't order it stat shares part of the responsibility, but your employer does not have to be fair when meting out punishment.
Im not sure why you thought I wanted a prediction of our future dealings but I was simply seeking input, perspective, without relevance to either side, but towards the entire issue, to be used by me and others to improve resident care.
I was definitely not seeking validation. If I was I'd have bolstered my involvement in a light that indicated correctness and one that was above reproach. I summarized what occurred. Maybe I should have included what is the norm to paint a broader picture.
In the past the chart would have been signed indicating the med was passed. This would have become the trend. Who knows when the med would have been ordered? I know from experience. I discovered a resident went two weeks without receiving her Corgard. I found out because I could not locate it to pass it. Tried to get it from the pharmacy who advised they didn't have any records of the order for that med. Thank goodness in this instance the resident did not suffer any obvious harm.
What purpose would it serve to seek validation in a situation like this. I know there are issues with the way meds are ordered, received and administered. I did what I knew to do based on my very limited training and experience. My goal of the thread is to gather as much information as possible and submit suggestions for improvement to improve resident care. As I said this has happened before and has not been reported. After this incident I understand why. Others did not want to place themselves on the chopping block. There should be a process where one should not have to think twice about getting the med for the resident. Unfortunately the current system focuses on each problem as it continues to occur rather than search for a root cause and correct the issue from origin.
Yes the order was taken from the Dr. at 1300. It is not clear when it is supposed to be initiated. Based on my training and experience, which is not extensive, I would think the med should be obtained as soon as possible. I would also think that the diagnosis that is being treated would have to be considered as well. Yes, the Depakote is used to treat seizures, however, it is so used to treat mood disorders and as a headache prophylactic, none of which were written on the order in the MAR.
In in this particular situation since I did not take the order I am not aware if a start date and time was communicated.
Yes the order was taken from the Dr. at 1300. It is not clear when it is supposed to be initiated. Based on my training and experience, which is not extensive, I would think the med should be obtained as soon as possible. I would also think that the diagnosis that is being treated would have to be considered as well. Yes, the Depakote is used to treat seizures, however, it is so used to treat mood disorders and as a headache prophylactic, none of which were written on the order in the MAR.
In in this particular situation since I did not take the order I am not aware if a start date and time was communicated.
Well, a medication order must ALWAYS contain a few specifics to be a valid order:
1. Medication name
2. Route
3. Dose
4. Time
5. Frequency
If the order doesn't state those things, then how can you be expected to administer said medication? You can't.
I absolutely agree. In this situation the order was for: Depakote 125mg 1tab, PO, bid. However, once transcribed into the MAR there was not a signature, there was no specific start date or time.
I absolutely agree. In this situation the order was for: Depakote 125mg 1tab, PO, bid. However, once transcribed into the MAR there was not a signature, there was no specific start date or time.
So the first dose should have been scheduled for that evenings at the latest. The morning dose the following morning would have been dose #2. Seems to me that the write up should be on the nurse who input the order, or who missed the initial dose that first evening.
I absolutely agree. In this situation the order was for: Depakote 125mg 1tab, PO, bid. However, once transcribed into the MAR there was not a signature, there was no specific start date or time.
So with an order written at 1300 for a BID med, a prudent nurse can reasonably conclude that the first dose is to be given that evening. And if you were the nurse who accepted the order at 1300, I would agree you should have called for it from the pharmacy then. The evening nurse should have done the same and then you should have followed up again the following morning when you noticed it wasn't there.
Adele_Michal7, ASN, RN
893 Posts
I agree with Brandon. And always chart that you called pharmacy, their response, etc.