RN that mixes meds in residents food and ask CNA to feed

[summerzippsalong]

I am a RN and was recently visiting a family friend at a LTC center and witnessed an RN mixing crushed meds into a residents snack of ice cream and then it was given to CNA to feed to the resident. I was very troubled by these actions and made a call to the DON the next day. The response I received was lacking in professionalism.

I later found out from another CNA that my family knows that works there that the same RN has forced her to to the same thing and when she refused she said she would write her up for insubordination and lie about the meds, because the administration will believe an RN before a CNA!

There are no unions at this facility an they are a at will state. I know this CNA is terrified to say anything because she loves and needs her job. Just looking for a way to help without getting her in hot water. I have worked in LTC as a CNA before becoming a RN and I totally get how stressful it can be but I feel that this is not right and something needs to be done.

[caliotter3]

The CNA should look for a job elsewhere. An anonymous complaint to the state might be in order, but everyone will know who made the complaint. Make a complaint to the Board specific to the RN who is doing this. Should be willing to testify as to witnessing the offense though. Again, it will be clear who is doing the complaining. One place where I worked fired a CNA who was administering meds when a family member complained. Until the family member complained, everyone always said it was ok, "because she is an RN in her country".

[WKShadowNP, DNP, APRN]

I'm having Déjà vu

[TheCommuter, BSN, RN]

Sometimes a very demented resident's care plan is written to reflect that essential medications may be hidden in favorite foods prior to administration. Of course, a physicians' order is also in the chart to cover this action.

Nonetheless, only licensed nurses (and medication aides in non-acute care settings) and physicians can administer these drugs. Medication administration is not a task that should be delegated to a nursing assistant.

[Sour Lemon]

I've given crushed medication to CNAs to administer to patients, although I was standing by when they did it. I verified the dose, patient, etc., then turned it over. Sometimes patients are only receptive to a particular care-giver and won't take any of their medication otherwise.

I've done the same thing with family members on occasion, too ...and with other nurses. I don't see any problem with it depending on the level of supervision and accountability. If I handed them a bunch of medication and sent them skipping down the hall, that would be different.

[Nursekrn7]

The RN responsible for administering the meds must be so careful, and MUST, some way, some how observe that all of the meds are consumed.

I work with the dementia population, and it can be very difficult to get the residents to take their meds! If there is a doctors order "May crush meds and mix with food" and it is documented in the care plan, than it is totally okay. However, I don't think that should be left in the responsibility of the CNA. I know there are some CNA's we trust, and others you cannot. You never know what could happen in the process of feeding, what if there is a new medication in there, that the patient suddenly has an allergy reaction too, or what if there is an emergency and the CNA has to run off, OR what if the CNA just doesn't care that the patient is having a difficult day and doesn't finish more than half of the food with the meds inside and neglects to report that to you? There is just a lot that can occur. I am also in LTC and have been for over about 13 years. Everyone has shortcuts. But when it comes to medication administration, there should be none. At the end of the day, we all work hard and worked hard for our licence! It would be a shame to kiss it gone over a silly preventable mistake.

[ClaraRedheart, BSN, RN]

One way to prevent this is to crush all of the meds and feed it in one spoonful. Let the CNA feed the patient the rest of the applesauce to get the taste out of their mouth. I've never had a patient that has had a problem with this strategy. As many patients as I usually have, I rarely have time to sit and feed a patient a whole pudding while I've got 2-3 other patients waiting on pain meds and other critical medications.