Opinions please!

Nurses General Nursing

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I need some feedback regarding an issue that I encountered at work today. I work in the LTC setting and we are still using a paper MAR system. I am a FT regular on a hall that I have worked on for many years and I today I was written up for 12 med errors and had disciplinary action taken against me for something I technically did not do. I am a reliable employee with a clean record - I have never been written up for anything in my life. One of my residents receives Levemir every evening per MD order. When I am done popping all of her evening medications & drawing up her insulin (using the 5 rights/3 checks) I administer the medication & insulin. Following administration I sign off on all meds (which she receives several pills at that time.) Anyways, since September started I have missed signing it off on the MAR. The resident is A&O x3 and has given a statement to the director of nursing that she always gets her medications as ordered (including her Levemir.) She if very much aware of all of her meds & knows if something is missing. The vial of Levemir which was opened 8/29 is a little over half full, showing that there was insulin that was drawn from the vial in the month of September. However they are still accusing me of not administering medication as ordered by the physician. I understand that it is my fault that I didn't sign & I am more then willing to take the blame for that. But it was a simple human error - not a med error. I normally check the MAR prior to leaving but I still overlooked it. Her blood sugars have been stable and consistent the entire month. They called and reported it to the MD and family that I didn't administer the insulin for the entire month of September when I really did. I just feel like everyone is looking down on me over a stupid error. Am I wrong to feel this way? Any worlds of advice?

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Welcome!

As you probably already know, if it was not documented, then it was not done. It doesn't matter if you really did administer the medication. If there are unsigned holes in the MAR, then the medication is considered to have not been given.

I'm so sorry this happened to you. We live and learn from our mistakes. Good luck to you!

I know - it is just so frustrating because I know that it was given. It makes me sick that people think that I didn't give the medication. I will definitely be giving my full attention to checking my MAR every shift & getting my co workers to check it for holes as well. Thanks for your input!

I have no doubt that you gave the medications. However, documentation is a pretty basic nursing function, and if it is isn't documented, then it isn't done. That's kind of simple. The facility is responsible for doing quality checks on the documentation, and missed documentation of medications, particularly several doses, is easy to catch. The facility could get into a great deal of problems with regulatory agencies for failure to catch and correct things like this. Instead of complaining about the disciplinary action, I would suggest that you admit fault, figure out how you let this happen, and come up with some steps to prevent it from happening again. You screwed up. Simple as that..

Specializes in Hospice.

You know you gave the med and the resident is able to confirm that you did. That's all well and good, you said you normally check the MAR before you leave, but had overlooked it. You overlooked it for 2 weeks.

It's very easy to become complacent when doing the same tasks over and over. Learn from this experience and check that MAR as though it was the first time you had passed meds to that resident, not the hundredth.

Specializes in Med-Surg, Emergency, CEN.

That's a crappy situation. Paperwork wins over common sense these days. I hope things look up soon.

Specializes in Reproductive & Public Health.

There's nowhere else in your charting where you might have referenced med admin? We use a paper MAR at the place where I work as an RN, but any meds that require an assessment or are prn are also charted in our EMR- maybe not the exact dose administered, but the assessment and a reference to the order & admin time.

Specializes in OB.

There is a significant issue if you missed charting meds on this pt for two weeks. This could have serious consequences for the pt if the next nurse saw the blanks and assumed the meds were not given.

I'd advise that you accept responsibility for the error with no excuses and present your supervisor with your plan of action to assure that it doesn't recur.

No unfortunately there isn't anywhere else that it is charted (all of our PRNs/blood sugars are paper as well.) And I did take responsibility for not signing and of course made a plan of action to assure all medications are signed off. I am just frustrated with the situation, I am not saying that I didn't do anything wrong, I was more or less just trying to vent.

The resident gave a statement that she received the medication and there was objective evidence to support her statement, yet the management chose to deceive the physician and the POA by telling them you didn't administer it. I would ask the management, when the physician was told the patient's blood sugar levels were stable without insulin, did he believe it? If so, he should have discontinued the insulin, since it would seem the patient no longer needs it.

Specializes in OB.

I understand what you were saying. My advice was just on how you should present to higher ups. This is what they want to hear and will reflect better in their eyes if they perceive how seriously you take this.

I can see why you are venting, when the management lied, they violated the ethical principle of veracity, two wrongs do not make a right.

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