Help and Advice!!! Question with Med Pass

Daytonite, BSN, RN · Jun 25, 2008

i think you are right to be concerned. yes, you need to report this to the program coordinator if that is the next person up the chain of command. here is the thing, however. you need to focus on the facts and try very hard to keep your emotions out of this. what your instructor is doing is against most established written policies and procedures and that is what you need to emphasize and report by citing the specific examples so her boss has concrete evidence to support her wrongdoing. then, at the very end of your meeting express your concerns for any retaliation by this instructor if that concerns you.

when i became a supervisor and manager, discipline was one of the hardest things to deal with--at first. after the first few instances, it got easier to confront people. it's interesting. sometimes people genuinely don't know they have done something wrong, are horrified and bend over backward to correct the error, learn from it and move on. then, there is another group who is cutting corners, took a chance, got caught, and have no defense for their actions. some of their attitudes about getting caught can be real interesting. a few are like career criminals--they look at it like they need to be more careful about not get caught again and are never going to do things the right way--i kid you not! a few are going through personal problems and the wrong behaviors at work are a manifestation of their coping and anxiety. none of it, however, is excusable because it puts patients safety at jeopardy.

Nurseinprocess · Jun 25, 2008

My first clinical instructor had us sign off the meds on the MAR before entering the room and actually administering them also. I don't understand why you hadn't checked your patient's pulse right before you went to the instructor with your meds in hand to administer them? You should be on top of what is going on with your patient right before you are ready to pass meds, so you know if their vitals affect whether or not they will get them, or if your patient isn't ready or wanting to receive a breathing treatment.

I have seen many people administer meds this way. What is the proper way if this is wrong?

Daytonite, BSN, RN · Jun 25, 2008

my first clinical instructor had us sign off the meds on the mar before entering the room and actually administering them also. i don't understand why you hadn't checked your patient's pulse right before you went to the instructor with your meds in hand to administer them? you should be on top of what is going on with your patient right before you are ready to pass meds, so you know if their vitals affect whether or not they will get them, or if your patient isn't ready or wanting to receive a breathing treatment.
i have seen many people administer meds this way. what is the proper way if this is wrong?

excuse me, but i have been an rn for 30 years. i don't know what they are teaching in nursing school these days, but i was taught something very different. i can't imagine that the rules of good nursing practice have changed in 30 years. i never sign off a med until i have given it. i took the mar into the room with me or kept it on the med cart which was parked right outside the patient's room or possibly rolled right into their room. and, i don't take the patient's pulse until i am standing there at their bedside with the digoxin as well. how's that for being on top of what's going on with the patient as well as making good use of my time?

what happens if someone signs off that they gave a med, gets distracted and called away to something going on with another patient, the med never actually gets given and it ends up getting totally forgotten about? later on the patient asks where his medication is because he never got it. not according to the mar! he looks like a liar or that he is confused to another nurse who has no idea of what is going on. medication error!

medication that doesn't get given should not be signed off, or if it has been signed off, should be circled and initialed or otherwise indicated that it wasn't given. medication that was removed from it's packaging and not given to the patient should either be destroyed or locked up in the appropriate place depending on facility policy. as a manager i had to give written disciplinary warnings to several licensed nurses who just didn't want to follow the rules on administering medications and kept leaving them at patient's bedsides and/or not watch patients take them. i worked at a facility years ago where another confused patient walked up and took medication that was left at the bedside of another patient who was not in their room at the time the medication nurse came by. by all the luck in the universe, she was allergic to it and had an anaphylactic reaction almost immediately and would have died from respiratory arrest if she hadn't been found shortly afterward wheezing and having difficulty breathing. that's why you follow the rules.

just because people might be observed doing something one way a lot doesn't make it right. what kind of logic is that? that's like saying that just because everyone runs the stop sign at the end of the street it is ok to do it. then when somebody runs the stop sign and hits and kills someone and says, "but no one stops at this corner!" as a defense, does that justify what they've done? this is why facilities have written policies and procedures. some people just don't have any ethics and they have to be laid out for them.

the nurse responsible for leaving the meds that the confused patient took and was allergic to that i mentioned above. . .was fired. she protested loudly and made a big deal about saying that "all the nurses leave pills at the patient's bedsides". it was the gossip of the unit. that argument really was kind of stupid. she failed to follow medication administration policy and it was not true that all the nurses were leaving pills at patient's bedsides. i, for one, wasn't doing it.