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

[Lopezlvn]

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!

[KatiepooRN]

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.

[wooh, BSN, RN]

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.

[Lopezlvn]

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!

[wooh, BSN, RN]

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, MSN, RN, NP]

What happened?

[Mn nurse 22]

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.

[Mn nurse 22]

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.

If you gave the correct medication to the correct patient at the correct time, the correct dose, and the correct documentation why should you be getting the medication error?????? It should be the med aid who gave the meds at the wrong time and failed to chart them.