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Help, I'm stuck and unsure what to do??

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Lopezlvn Lopezlvn (New) New

I'm a LVN working PRN at a

upscale facility, which I enjoyed because although strict it ran very smooth. Hardly any incidences, falls, great state surveys and great employees.....until last night! I worked 2-10 shift and have a CMA, I was also training another nurse. My Adon came up to myself and the trading nurse and said the CMA is behind help her get caught up on her medications that haven't been given from 2000, 2100, and 2200! Apparently the med aide gave all her pills early an didn't chart on our EMAR. So, doing as my Adon said I looked at EMAR and the new nurse and I started passing meds. I see CMA diddling and I asked for assistance with "her" med pass. At this point the CMA said she passed all the pills. I said why didn't you document, if not documented it wasn't done??? CMA said the DON told her to finish meds by 2000 on aide "B" and go to side "A". I went directly into Adon office and informed of this and ADON said " don't panic, keep your mouth shut or state will be in here" I said no, it's not right! The Adon then repeated this to the CMA, training nurses an oncoming nurse to "fix" med count and not hand out norco on morning rounds to "make count accurate". At that point I called the DON an informed her what transpired and was reamed a new one and that I should have communicated with the med aide. I informed the DON that nursing 101 is if not documented wasn't done. Don told me to call families and doctors and not place blame on anyone! I said I don't feel comfortable with that, so she hung up and I proceeded to type note to administrator and she called back and said not to call anyone she called family and I was to leave premises.

Sorry so long but here is my question, do I report the facility, my DON and Adon and myself or how do I go about this? I dot feel as though I did anything wrong, I followed protocol and haven't received call from administrator.

i feel as though if I don't inform the Texas BON this could back fire. Any help is appreciated it!

So at the direction of the ADON you relied on a MAR that indicated no meds had been passed, and found out halfway through the med pass that patients had already gotten their meds, and now you'd just given second doses? Is that right?

I would definitely call the BoN and tell them this story, and send it to them in writing with a cc to the DON and the owners. You might be getting set up to get fired, but at least you should get your story out there before they come gunning for you.

And the "med aide" who didn't chart her meds should be fired.

Lev, BSN, RN

Specializes in Emergency - CEN. Has 7 years experience.

Find a new (PRN) job and then report the med tech, DON, and Assistant DON to the BON. If you do it beforehand, you will be fired most likely. Don't speak about the incident to anyone, not even your coworkers, until you leave the facility.

xoemmylouox, ASN, RN

Has 13 years experience.

If you have malpractice insurance call them. Accept that you're about to be fired. Write down exactly what happened and who was working. Use no pt names. All I can hope is someone watched over these pts that were double dosed. They needed to call the Doc too. What a mess!

Even if you are not fired, you need to get out of there fast.

nurse lala, BSN, RN

Specializes in Psych. Violence & Suicide prevention.. Has 42 years experience.

LopezLVN,

I don't think there is one among us who is not aghast at what happened. My chin dropped when I learned the ADON made a decision without even speaking to the individual assigned to pass the meds! We are all rooting for you.

Thanks guys...lots of good recommendations. I did leave note in HR and administrators office. The Adon placed on administrative leave until investigated and all parties involved were contacted. Long story short they blamed on me and said if I would have had communicated with the med aide this never would have happened! I told administrator and DON that the med aide gave meds 2- 3 hours in advance and didn't chart she gave!!!! They went right past that comment and ignored. The ADON fired, and I did tell them I won't work in conditions like this and be concerned to "do the right thing in fear of retaliation. I'm a good nurse and know I did right thing. I kept my letter that I gave to administration.

As far as pts were concerned I stayed and took V/S and made sure they had no adverse reaction .

Thanks again guys!!

If feel as though I should report them but concerned that'll get blamed.

You've already been blamed. Report the hell out of them. It is not your negligence that the med aide was improperly trained as to the importance of charting timely. Cover your butt with the letter to the BoN, send a copy to the state, and get another job (in approximately reverse order).

Lol, already have a few PRN jobs. Not worried about that but I will contact BON tomorrow and see what I can do.

thanks

I don't see where an incident report was done. That is only thing I can add about the situation in retrospect. Sorry, this happened to you. Real problem is chronic understaffing of these facilities. They then, have poor training, increase use of unlicensed staff (med aides instead of LVNs) set the staff up for falsifying documentation (pre-charting), poor care, etc. Yes, you bear some blame for not getting some type of update or report from the Med aide/tech and BON will probably sanction your license. I would make sure you have a full time job as they will not allow you to work staffing or multiple part time jobs if they do. You will get through it. Keep your head up.

That's what is sad, I get punished for a med aide not documenting and givin medication 2 hours before scheduled time. I've always been trained if it's not documented, it wasn't done. Just upset I get punished for being a nurse that follows the rules.....guess that'll teach me! They only filled out medication error forms and I had to sign em. I asked for copies and they refused.....I said just blk out pt name so I have documentation of the incidents along with my letter to administration.

You are the one with a license- not the med aide. You should have communicated with the med aide first before immediately jumping on to help per suggestion.

In ltc, it is very common practice to pass some meds early if the resident receives the majority of their pills at an earlier time and has a med or two that fall at different times. If someone has 4p and 6p meds you can sure bet I am combining them if not contraindicated. Also, keep in mind that there is a two hour time window to pass meds... so at 5p it is perfectly okay for her to be passing 4p and 6p meds. So "2-3 hours early"really may not be that early.

Just because "not documented" is "not done" doesn't mean it's NOT DONE. I always ask the person responsible for giving meds before I go and give their patient meds. Because it's prudent to double check and make sure that they haven't given something without getting around to documenting yet.

Med aides actually do have licenses, and I have never given medication and not charted. She gave narcotics along with all medications indicated for 2200 @1930, so I'd say that's dangerous!

What she did is on her. But YOU should have asked if medications were given by the person still passing meds rather than assume they weren't.

Lev, BSN, RN

Specializes in Emergency - CEN. Has 7 years experience.

What happened?

Med aides actually do have licenses, and I have never given medication and not charted. She gave narcotics along with all medications indicated for 2200 @1930, so I'd say that's dangerous!

I agree that is dangerous. The MD should have been called immediately on all the patients who were given the wrong meds after checking their allergy lists. Families should have been contacted and VA reports filed.

While I understand the staff person who tries to combine med times why not change the medication time so that you are in compliance when giving it early or late?

Sometimes a medication can get entered at a weird time but it doesn't take that long to update the MAR so it is scheduled at the time you feel it should be administered, as long as there aren't contraindications for changing the times.

This incident just illustrates one of the many reasons to give meds when they are ordered and chart them immediately.

The nurse in question should not have had to double check if someone was breaking multiple rules of medication administration before jumping in to help.