Fentanyl Patch med error

[nursesaysay]

I am a LTC nurse. To make the back story short, pt has Fentanyl Patch to be changed Q3days, only applied to upper back out of reach, old patch must be discarded(wasted into sharps container) by two nurses & signed in narc book by both nurses. One day, I went to change patch as ordered, the previous patch was not on patient but was signed out in narc book (next to signature reads "old patch wasted" but no co-sign from second nurse). I then found an even older patch. Did full body audit with second nurse, could not locate patch that was supposed to be on pt.. Filled out appropriate med error paperwork, left with supervisory staff.

Next day...I am called to director of nursing office. She says "It seems like you only find med errors when per diem nurses work, call me crazy..." I am pretty upset/offended. I am full time on my unit, and yes mistakes happen BUT this mistake is a narcotic error! The nurse who placed the older patch on the pt was a PRN nurse yes, and likely just discarded the new patch innocently. However, that is not my job to figure out. There have been two other occasions where per diem nurses have incorrectly placed the Fentanyl patch on this particular patient IMHO, why is my director coming down on me? I feel the concern should be with the per diem staff members who are not educated on proper placement of the patch!

Just wanted some input - would you be offended if your director said this to you? How would you respond? I was dumbstruck, so I just nodded my head at the time.

[WKShadowNP, DNP, APRN]

How is a brand new missing fentanyl patch a process error? It was signed out of the emr and never placed while the old one was left on for 6 days?

If I remember the OP correctly, this is another med error in a string of errors found by the OP, and attributed to various per diem staff.

[BeenThere2012, ASN, RN]

How is a brand new missing fentanyl patch a process error? It was signed out of the emr and never placed while the old one was left on for 6 days?

I think the point here is that regular staff are following the policy and the per diem are not. Something in training perhaps?

[BostonFNP, APRN]

I think the point here is that regular staff are following the policy and the per diem are not. Something in training perhaps?

I would buy that if this was simply an old patch that wasn't signed out. But this is a brand new patch that is missing.

What part of training covers "when you take a narc out make sure the patient gets it"?

[BeenThere2012, ASN, RN]

I would buy that if this was simply an old patch that wasn't signed out. But this is a brand new patch that is missing.

What part of training covers "when you take a narc out make sure the patient gets it"?

I understand your point on this particular part of the post. I am saying that, according to the OP, there has been more than one "error" regarding proper handling of Fentanyl patchs with "per diem" staff.

Maybe I am missing something, because I still don't understand why the manager was chastising the poster for correctly reporting errors she found. Not making sense to me.

[BeenThere2012, ASN, RN]

I would have asked her how she preferred I handle similar situations in the future, let her back-peddle for a few minutes, then gotten on with my day.

This is an excellent response for any number of subjects where we are "chastised" and it doesn't make sense to us. OP, I think you should get clarification from the DON on what she is implying and what she expects you to do.

[ShelbyaStar]

No matter what, an error was made. Even if the newer patch fell off, that would mean it was put on without removing the old one. Still a problem. Management lashing at you over it is a big problem- as others said, what exactly else are you supposed to do?

[BostonFNP, APRN]

there has been more than one "error" regarding proper handling of Fentanyl patchs with "per diem" staff.

. Not making sense to me.

This is a huge problem! You'd think the director would be irate about it!

Unless the director is involved...

[Workitinurfava, BSN, RN]

I guess I am just different because I don't care who you are, I will not be disrespected in such a manner. I have confronted my manager, Drs. and techs on their abusive comments. I learned along time ago that people like to take their problems out on you. It is my job to not let them do it but yes remain professional for sure. Once you set them straight, 99% of them times you won't have a issue with them anymore. Abuse is unacceptable and I would have called her out on her comments, "In a professional way of course". I have never been fired for it either because I know my stuff, and am a hard-worker. That is something they can't deny.

[nursesaysay, LPN]

Oh it's possible! The issue is this: nurse on 9/19/16 wrote that she discarded patch from 9/16/16 - however, I found the patch from 9/16/16 still on the pt upper back...clearly it wasn't discarded. It's a mistake, and I know they happen....but this is the third time a per diem nurse working my floor on my day off has messed up this patch. Ugh!

[nursesaysay, LPN]

I've been a nurse for 4 years and I never have worked anywhere where RN/LPN does not get a co-sign from a second nurse when discarding an old Fentanyl Patch. I thought this was nursing 101. Basically, my director says since I am a "senior nurse" I should be "educating staff" rather than reporting them. I am totally OK with educating, however, a controlled substance error isn't something I can just approach another nurse about later on - this is a reportable issue, as I was not discarding the patch from 9/19/16 but rather the patch from 9/16/16. Plus, my poor patient did not have proper pain management as the patch on her was no longer working, thankfully no adverse effects were noted. I have now decided to check the placement and date on the patch every shift when I come in...perhaps I will ask our on-site APRN for an order to have all shifts check the patch on the patient during shift change. Seems like a ridiculous thing to have to do, but I'm at a loss here and I have no help from management, clearly. Yes, I could go above my director, but she is very well liked within this corporation, and this will likely backfire on me. Again, thank you all for your support!

[AceOfHearts<3]

I've been a nurse for 4 years and I never have worked anywhere where RN/LPN does not get a co-sign from a second nurse when discarding an old Fentanyl Patch. I thought this was nursing 101. Basically, my director says since I am a "senior nurse" I should be "educating staff" rather than reporting them. I am totally OK with educating, however, a controlled substance error isn't something I can just approach another nurse about later on - this is a reportable issue, as I was not discarding the patch from 9/19/16 but rather the patch from 9/16/16. Plus, my poor patient did not have proper pain management as the patch on her was no longer working, thankfully no adverse effects were noted. I have now decided to check the placement and date on the patch every shift when I come in...perhaps I will ask our on-site APRN for an order to have all shifts check the patch on the patient during shift change. Seems like a ridiculous thing to have to do, but I'm at a loss here and I have no help from management, clearly. Yes, I could go above my director, but she is very well liked within this corporation, and this will likely backfire on me. Again, thank you all for your support!

We have required checks on fentanyl patches at my hospital. I think it's every 8 hours that we are prompted by our electronic MAR to verify placement. I know the hospital is a different setting compared to LTC, but it seems like a good idea to me to still verify the patch is on every 12 hours- that will help you determine the time frame if it goes missing and, maybe even more importantly, ensure the resident has adequate pain coverage.

[dec2007]

Yes, I would be offended! Her response sounds oddly personal, like perhaps she is a friend of said PRN nurse and is covering for her. Step carefully when you speak with this one! She sounds devious.