Help, I am very conflicted about turning peer into nursing board

[auntie72]

I have a floor nurse that administered medication to a patient after the order was dc'd, he failed to draw stat labs, and this patient ended up at the hospital with renal failure and anemia. That same nurse also initialed that he gave a procrit injection as a one time order, but the pharmacy never sent out the medication because it requires admin approval. These 2 instances where written up and given to the DON and the administrator. The MD was very upset and the administrator said this employee would be fired however he is still working and the write ups havent been issued to him. These write ups would have been his dismissal becuase he has already had so many and was given his final last week. I am torn. I feel like since our admininstration isnt doing anything about the unsafe care this nurse has a history of that I should report it to our local nursing board. I know everyone makes mistakes, however this is his trend and it puts our patients at risk. Please give me your thoughts.

[talaxandra]

The issue here, according to the OP, is multifactoral:

1/ administered medication to a patient after the order was dc'd

2/ failed to draw stat labs, and this patient ended up at the hospital with renal failure and anemia

3/ initialed that he gave a procrit injection as a one time order, but the pharmacy never sent out the medication

I can understand meds being ceased and overlooked the way Sue described above. Things are quite different here - when a drug is ceased it's crossed through on the drug chart by a physician and quite difficult to miss. In acute care, or at least in my group of hospitals, Warfarin doses are only written three days in advance max, and often prescribed daily. However, mistakes still happen - extra doses, skipped doses etc.

What concerns me most is issue 3: he signed giving a drug there's no way he could have administered. That's a lot harder to plausably explain away.

[SuesquatchRN, BSN, RN]

Hey, I am not saying this guy's a good nurse, but aside from signing for Procrit that wasn't given, we don't know anything about the rest of it. Did he ever even see the orders for the labs?

I just don't know. I am unwilling to collectively throw him under the metaphorical bus without being there.

[talaxandra]

That's why Boards of Nursing take a long time to investigate.

[CoffeeRTC, BSN, RN]

Can someone tell me more of what an MDS coordinator does? I do MDS's at work but I'm only going through the nursing part. I don't look at the MAR's to find errors. I thought (and I'm very new to the whole process) that is was basically keeping us on track with proving our billing mathes our pts and whats going on with them. Anyone with knowledge care to input?

The MDS nurse or assessment coordinator or medicare nurse or RNAC does many things. For the most part they coordinate the assessment process which includes care plans and the MDS (minimum data set). The MDS shows the insurance co and medicare/ medicaid what level of care the resident is getting. They reimburse the facility based on that. In order to complete the MDS, there needs to be proof of care. Looking thru the assessments completed during a set period of time includes looking thru nurses notes and all documentation including the MAR and TAR. Often times when you are looking thru notes, md orders, labs and MARS/ TARS I would pick up on a ton of things that could have been over looked. This is how the error could have been found.

In some places the RNAC or MDS nurse does more than that just the MDS and care plans. They can be considered part of management, salaried or hourly, they can be incharge of other things like restorative, infection control, incident reports, wound teams, nutrition and behavior teams. It all depends on how the facility is set up. In mine..the RNAC is somewhat an ADON or DON stand in and part of management. So being in the know and involved in a situation like this isn't unheard of.

My take on the whole isssue is that the OP can be concerned that it will just be swept under the carpet. Lets face it...things like this happen and happen in LTC.

To be honest..I forgot what the origional question was??

OP..can you just ask the DON or ADM what is going on with the situation if you are concerned about it?

[PsychNurseWannaBe, BSN, RN]

Are we in a SNF? Then file a complaint with the state. The state will investigate and they will report the nurse to the BON (normally) if they find substantial proof.

I will say this. Go to Admin and if state shows up.... you are probably toast if the facility gets a cite. Admin was already made aware. They made their decision (or lack thereof)

There should be a hotline you can call.

I don't know all the details. But ultimately you have to live with your decision.

[tokmom, BSN, RN]

http://www.silenttreatmentstudy.com/silencekills/

You don't have to read the entire thing to get the gist, but let's say it's a very scary read.

[TrafalgarRN]

Silence Kills ; Patient Safety Comes First; I never overlook when co-workers endanger patients through shortcuts. My family use the ED where I work and I want to be comfortable knowing that the right steps are being followed by in providing care. That goes for them and their families too.

To the OP:

1. How come that the other Nurses never Reviewed the Chart? Was this nurse working straight 24 hours? I thought nurses were supposed to review their charts every shift? When i worked in a place with paper charts, i used to review the orders placed in a chart for the last 24 hours and ensure they were implemented despite getting report from the previous shift.

2. Stat Labs were ordered; the next shift got report that labs were ordered/ drawn ...or lets say they were not informed. Then it goes back to point 2 where i stated how come charts were not reviewed ? A LTC is a 24 hour care facility and things don't stop after 8 hrs...there are 2 more shifts. If the other shifts got report that labs were ordered/ drawn how come no one followed up and if they noticed no labs drawn why were they not ordered and had to wait for 4 days? Incompetency?

3. How come a blood thinner was administered for 6 days in a row...was it just the one nurse who initialed it for those days? And if he did it, what systems do you guys have for discontinuing medications. I have seen LTC nurses yellow it out and write in red ink " DISCONTUNUED". Did some previous shift forget to do it? And back to my main question...why were the charts not reviewed?

4. Procrit initialed as given but never given...did he borrow it from another patient? Did he get it from stock? Did he initial it as given for 4 days? Again Chart and MAR review for any every nurse who works in that unit.

5. Your work place seems to be lacking some efficiency and responsibility of care. There are no good process flows and the nursing management needs to implement effective processes. If you are the MDS who seems to have extra responsibilities in reviewing charts then i guess your next task will be to review charts that have new orders and ensure the nurses implement them effectively...that's an extra task but you seem to enjoy it. If labs are ordered then there needs to be a lab log....signed and dated that labs were drawn and sent to lab e.t.c.'

6. BON is creating a mountain out of a mole hole. Let management handle it for now and if you feel they are lax then call the State. The BON will investigate but its a life time process. I know nurses in California who are still practicing 5 years after complaints have been filed with the BON...their crimes include diversion, patient abuse...e.t.c. I think your state DPH would be the next course of action.

7. Last but not least there seems to be a Vendetta against this nurse. Whats there between the 2 of you? Your investigations are not impartial since you are not investigating what role other nurses played had plus you are not even trying to think of what solutions can be implemented to prevent this from happening. I would love to hear the whole story and the role others played. Thanks

[lckrn2pa]

The first thing that ran through my mind when I read that the nurse documented but did not give the stated med was, "Wow, no wonder this pt was tx to the hospital needing several transfusions." Then I thought, "Holy cow. That stuff is expensive. I hope the pt wasn't charged for it."

I hope this gets handled properly by administration.

Dang it Canes, I just spewed mountain dew all over my freaking keyboard, I'm in tears over here laughing so hard.....

[DDdove, LPN]

Quote..." If admin does fire him, he is just going to carry on this poor nursing care somewhere else... Im not doing any patients justice if I let that happen...."

Why are you so sure he wouldn't learn from being fired or getting a warning? Maybe he got a warning but it is not information to be released to other staff. A med mistake like that should be used as a learning experience for the whole facility. Obviously no one was on their toes! Too many people handling that MAR and TAR in 6 days!

[JenniferSews]

Do you have a manager of your unit, or a director of nursing you can speak with? I was a manager for a while until I realized it was NOT what I wanted to do with my life. But I also learned a ton about how very hard it can be to prove that some people just don't deserve a job. He signed it? Well he signed it by accident but knows for sure he didn't give the blood thinner! He couldn't have given the procrit? Well pharmacy may say they didn't send it but I was there in the fridge. Maybe pharmacy messed up. Depending on the person they might be able to argue their way out of just about anything. IME shoddy nurses are usually very good at argueing and track covering!

Stat labs not ordered are the error of the person who signed them off and the nurse who should have done a 24 hour chart check, at least in my facility. But that was the final, "you can't argue this one." It still took at few days while we gathered all the evidence and still the process was difficult. I fired the person in question myself but he still called the DON, the administrator, the physician, other coworkers and everyone under the sun to argue his case. It was ugly and we needed solid evidence. It may not be that they are not going to do anything. Talk to your managers if you can to get a feel where this is going. If it's the kind of facility that lets someone like this continue to work then maybe it's time to move on. Worry less about the individual nurse and more about what this says about your facility, imho.

[passingthru]

I don't want to debate, but I once gave a long acting narcotic to a patient instead of the short acting, I called the physician, explained what happened and he gave me an oder to give the long acting at 4am instead of at 9am(this is an error by commission) If medications are initialed as given at 8am but are not actually given until noon is that not an error, is that not falsification? These are little minor errors and falsifications, but the fact remains , that these are errors and falsifications.

[talaxandra]

Obviously I can only speak for my own practice. I've certainly given the wrong meds, including narcotics. When we first began using oxycodone and OxyContin I gave the latter to a patient prescribed the former and didn't relaise until the shift change narcotic count. When I realised I notified my manager, the unit registrar and the patient, then wrote up an incident report.

If I give a drug that was prescribed for 8AM and midday I initial that I gave it at midday; if there's a reason why it was four hours late I include that in the notes and/or (depending on the reason) on the drug chart.

I'm not saying we're perfect, any of us. But I was taught that one of the hallmarks of being a professional is being accountable for the errors I make. Signing for a drug you couldn't possibly have given? That's not an error.