Would You Report Me for This?

[cupquake]

Hello fellow nurses. I have something to get off my chest, and I cannot discuss this with coworkers so I sought out all of your opinions. FYI: I am a new grad RN, currently working in LTC for about 7 months.

A few months ago, during a med pass at 5 pm (supper), I left a pill in the pill cup next to a resident who normally will take the pill, if not, the aide will help her take it (it was senokot). When I left it there, I acknowledged to the resident that I am leaving a pill beside her and would like her to take it. A family member of another resident sitting at the same table, saw this and commented "She won't remember to take that," in a very rude manner. In response to her hostile personality, I was firm and told her "She usually does take the pill, if she does not, I will follow up and be back to make sure she does". I left saying this and administered pills to the other residents at this time. I came back to the same table while giving a pill to another resident sitting on the same table as this family member and the original person I left the pill beside, I asked the aide "did A.I. take the pill?". The aide responded and said yes. I then proceeded to administer the crushed pills to another resident while waiting for her to finish IN FRONT OF this family member.

This family member then went to my director and reported me for inappropriate medication administration. I was written up for something that did not even result in harm or distress for a resident. I was disciplined for "leaving a medication beside a resident that has dementia," instead of waiting 5 minutes to help her take it, I proceeded to admin meds to the other 30 residents before time runs out.

I honestly feel like this is unfair. Also, my director was very strict and had a look of no mercy when telling me that this is just "unacceptable practice". Also, the family member who reported me has a history of issues with many co-workers, and the management team knows that.

So, tell me, give me your honest feedback. Would you write me up for this? I feel a sense of indignation towards my director.

[Rose_Queen, BSN, MSN, RN]

I would. It is not within the scope of practice for an aide to ensure medication administration. Meds also shouldn't be left unattended. Making sure the resident takes the medication is the responsibility of the nurse dispensing the medication.

[flyersfan88]

I have always been taught (and practice as such) from nursing school to present to never leave a med with a patient. You always witness them take it. It doesn't matter what the med is. You cannot rely on anyone else's account but your own that the med was taken.

[meanmaryjean, DNP, RN]

Just because it was a (in your mind) 'harmless' pill you left there, you still left unattended medication at the bedside. Of a patient with dementia. You were wrong here, and yes, if I were your director, I would write you up.

Your defensiveness tells me you have not learned anything important from this occurrence.

[cracklingkraken, ASN, RN]

Nursing school has told us to never leave an unattended pill and make sure the patient has swallowed the pill before leaving. There are many things that could happen otherwise, such as they could store/cheek the pills and try to OD.

[icuRNmaggie, BSN, RN]

I have never worked LTC. I personally think there's nothing wrong with letting an aide watch a pt take a senokot at mealtime provided that there are no swallowing difficulties.

My family member was in ltc for years due to dementia. The aides were very trustworthy and the care was excellent. I would not have had an issue if one of them supervised my family member taking a senokot at mealtime.

The DON may just be concerned about appearances. She may have needed to document something in case this visitor makes a report to an outside agency.

I think you need to shake this off and be careful around this visitor in the future.

[heron, ASN, RN]

I wouldn't necessarily write it up, but I would most certainly have a chat asap. It's bad practice anywhere, but especially in a setting with a high incidence of dementia.

Leaving a pill at the bedside to be taken later or given by a cna means you have no idea who took that pill. You have no idea if the resident who took the pill was able to swallow it effectively. You have set up a cna for acting outside her scope, possibly endangering her livelihood.

If badness can happen, it eventually will. Some corners should never be cut.

[Ruas61, BSN, RN]

Yes, counseling and disciplinary action were appropriate. You did not follow best practice. If I saw this practice with some friend or family member in a facility, I would cast a critical eye.

[Karou]

I wouldn't write you up for it in LTC. I know it happens, I witnessed it myself often when I worked in a nursing home. When you are passing medications for 30-40 residents, you do take shortcuts. We all know that isn't supposed to be how it goes, it is not the correct way to pass medication. It doesn't make it right but I can sympathize.

However, it wasn't very smart of you to say that and do it in front of a known problem family member. This is where common sense comes in. You got caught and reprimanded for doing something obviously wrong, but that many others do. When you take shortcuts and get caught you have to suck it up and accept consequences.

[madwife2002, BSN, RN]

I have worked in many hospitals, and the policy was always you do not sign for a medication you did not see the patient take or you did not administer. There are various reasons for this.

I suggest you just learn from this mistake and move on

In answer to your question would I write you up-Yes I might but I would get all the facts first

[MunoRN, RN]

If what you're doing is assisting with self-administration then no, you don't need to witness the patient taking the medication. If you're "administering" the medication then you do need to see the patient take it, and I know that's ridiculous when you're talking about senna but those are the rules. They can either take it now or not take it all, is it possible the patient just doesn't want to take it?

[RescueNinjaKy]

I would never leave a medication laying around. If they're not gonna take it now then I tell them that I'm going to lock it up and try again again or that I'm going to record that as a refusal.

And as for whether the medication is important or not, management isn't going to wait till you leave a narcotic or even something like lopressor around. They're going to initiate corrective actions before it ever gets there. If you're not following policy, they're going to reprimand you. As to what degree of action is at their discretion. Some may do a verbal warning, but perhaps they felt that you didn't own up to it so they wrote you up.