Med Not Available = med error?

[findingmywayRN]

I read a while back some posts about putting "med not available" on the med sheet if a med could not be located, and it seemed like this was a generally practiced proceedure for documentation. So, after not being able to locate a patients eyedrop late one night I circled it, and put med not available. Well I was recently reprimanded for this by my nse mgr who said I would be written up as this was an omission of medication. If it is late at night and the med is not there (in an LTC facility with no internal pharmacy), what are you supposed to do????? :uhoh21: I'm certainly not borrowing another patients eyedrop!

[Dixiedi]

What do you then do if they won't give you an order to hold the dose?

Most of the docs will give just about any order the nurse asks for. I've never had a doc in LTC or home care (matter of fact don't remember ever being turned down in acute care or corrections either) turn down an order i've requested.

[Blackcat99]

call the md or the medical director. ask to get an order to hold the dose. then put in the doctors order and on the mar "hold 9 pm dose of ....." as well as in the nurses notes, report sheet, etc.then you will be just fine. if the med was all that critical it would be in the emergency box for meds. :) :) :) :) :) :) :) :) :) :) :) :) :) :) :) :) :) :) :) :) :) :)

working in ltc is a battle of wits. there is only one way to do things and that is the right way. you have to have very sharp problem solving skills to survive in these places. think outside of the box.

this sounds like a great idea. thanks

[mother/babyRN, RN]

If you went to the length of following the policy and calling either your supervisor and or the pharmacist at home to report it, then documented that if it was not available, that you called the physician, it is not a med error....You can also circle a med not given on the med sheet and give no explanation there, document all the steps you took to get the med on the resident chart and fill out an incident report every time a med is not available..Those get reviewed and too many incidents do not a happy management team make...

[elkpark]

If you went to the length of following the policy and calling either your supervisor and or the pharmacist at home to report it, then documented that if it was not available, that you called the physician, it is not a med error....You can also circle a med not given on the med sheet and give no explanation there, document all the steps you took to get the med on the resident chart and fill out an incident report every time a med is not available..Those get reviewed and too many incidents do not a happy management team make...

Little, picky clarification: It is a med error, but it's not the nurse's error. Any time a med is not given in accordance with the physician's orders, it's a med error (unless the patient refused it). :) You are right about filling out incident reports and putting them into the "system." If the pharmacy is not meeting the residents'/patients' and nursing staff's needs, then management needs to deal with that.

[mattsmom81]

Hey, that's what I was told over 30 years ago when I was in school! Reality check... that's usually exactly what they are used for.

That is NOT what every facility uses them for. Blackcat's post is true in many cases...some places are looking for compliant nurses who will NOT write anything up,(OR will only document certain issues and not others) will just go with the flow, and take a fall themselves if required. Too many writeups may signal one is a loose cannon and not desireable as an employee. I have worked places like this.

I've also worked places where I've written up some serious situations, not just with medications but other issues..and they have disappeared.Also a supervisory situation once where I naively wrote up dangerous situations...it blew up in my face; I was doing what I thought was right and TPTB did NOT appreciate it.

[CapeCodMermaid, RN]

You've never had a doc refuse an order???? Zowie! We have a doc who won't order chest xrays because he says they cost too much. Cripes ! I'm a cheap Yankee, but HE's not paying for them. Y'all don't know how lucky you are.

[Dixiedi]

You've never had a doc refuse an order???? Zowie! We have a doc who won't order chest xrays because he says they cost too much. Cripes ! I'm a cheap Yankee, but HE's not paying for them. Y'all don't know how lucky you are.

I got to thinking about it for awhile after I said I had never had a Doc refuse an order for me and ya know what, I can't ever remember, in over 30 years, asking a Doc for an order that I didn't already know he would say yes to.

Now I have to start rethinking my thinking. Am I backing down before I even confront the Doc or have I just been lucky?