How does your facility confirm you are giving all your meds?

[fairyluv]

we had an issue at my LTC facility that a nurse was not giving all the meds and once it was confirmed, she was let go. Now the way they went about it was really wierd. Resident had a peg tube and all meds were given thru his peg, there was some suspect that he wasnt getting his meds. So there was a note placed under the residents gown by the peg tube stating that whoever found it was to turn it in to Admin. it was found and turned in on the next shift. they terminated the nurse after determining that she was not giving him his meds. is this a normal way to confirm this ??

[AngelRN27]

I'm not sure how to answer your question about HOW to confirm whether or not meds are being given, but I can say that the way they went about it doesn't really confirm anything... all of my LTC residents that are on PEGs can have their PEG accessed without lifting the gown, especially when they are in bed and attached to their feeding pump.

The only thing I think this can confirm is perhaps that the nurse in question did not provide PEG site care... apart from that, not much can be gleaned from it. Also, let's say they used this method to check whether PEG site care was being provided... this would only prove that they did not provide it during the one shift where this note was left. It does not prove any prior incidence of such.

Also, isn't leaving this note on the resident a dignity issue?

[TheCommuter, BSN, RN]

In LTC facilities where old-fashioned punch medication cards and medication bottles are used, there really is no surefire way to confirm nurses are administering all meds as ordered if the nursing home has no way of electronically recording it.

If a Pyxis machine is being used, management can confirm the times the meds are being removed. If a scanner or portable laptop is a part of the medication pass, we can see what time the patients are being scanned. Until all LTC facilities computerize their processes where meds are involved, there's no way to know if a nurse is giving meds.

[SuzieVN]

Infection control issue. Dignity- can it get any less dignified? FACT- the person could have found that at ANY time, and held onto it, if she wanted to get that nurse in trouble. Rarely do I suggest a lawyer- but in this cae the nurse was fired and accused of neglect (not giving meds). Serious, and that place is seriously insane. Also- why take it to the ADMIN, not the DON? I smell e. Coli.

Other ways to 'case' a suspect nurse:

-Count non narcotic meds, on blister packs, before her shift. When she leaves, check MAR against prior # of pills.

-In extreme cases, like a seizure- get blood levels of Dilantin, and go from there. Some places I worked- that med, and others have been added to the narc count, since so many nurses don't give it?

-Ask alert patients what meds they received at any given time. This can be asked as QI survey:"It's just another tool we use to be sure you are getting what you are ordered, is all, much like you attend a care plan meeting". Then check the MAR. If you're hearing patients omit meds that have been signed off, you can start to take a closer look.

-Find a med that has run out, and therefore not available to be given, before her shift. Then check MAR to see if it's signed. If yes, good cause to ask here how she gave it. If she says she ordered it, that can be tracked. If she said she ... borrowed it? You just found another can of worms.

-Glucometers store readings for whatever period of time they are designed for. Easy to check if a nurse is making those readings up- nto everyone knows they have a storage capacity.

[SuzieVN]

In fact- an easy way to determine if you have a problem with any nurse not giving meds is to remove one med (one that isn't common, to prevent the 'I borrowed one' excuse) from her cart prior to her shift. See if she looks for it, asks about it, tries to order it- or just signs it out. You could test the whole staff in a day or so. If they come to the supervisor looking for it- say, "Oh, I'm sorry- I took that to my office because the pharmacy called me with a question."

[CapeCodMermaid, RN]

I think you all must work in really horrible places. For anyone to stoop to putting a post it on a person's body.....pitiful

[SuzieVN]

"Don't knock it if you haven't tried it!" (Obviously, that's said tongue-in-cheek).

[fairyluv]

I'm not sure how to answer your question about HOW to confirm whether or not meds are being given, but I can say that the way they went about it doesn't really confirm anything... all of my LTC residents that are on PEGs can have their PEG accessed without lifting the gown, especially when they are in bed and attached to their feeding pump.

The only thing I think this can confirm is perhaps that the nurse in question did not provide PEG site care... apart from that, not much can be gleaned from it. Also, let's say they used this method to check whether PEG site care was being provided... this would only prove that they did not provide it during the one shift where this note was left. It does not prove any prior incidence of such.

Also, isn't leaving this note on the resident a dignity issue?

that is what I thought to. the resident doesnt speak, so if someone where to ask him or something he wouldn't be able to say, and he has family members who visit regularly, I was concerened about how it would look if one of them found it. Gosh I wish I could find another job, but it's so hard.

[AngelRN27]

Other ways to 'case' a suspect nurse:

-Count non narcotic meds, on blister packs, before her shift. When she leaves, check MAR against prior # of pills.

THIS^^^ Apparently during my first month of employment at my current facility, there was an alert and oriented patient that accused a nurse (whom was already generally distrusted, for reasons unknown to me as a newbie at the time) of not giving her meds for two consecutive days during her 3-11 shift... The DON decided to count all of the meds for 3 of this nurse's residents. The DON then had the 11-7 supervisor compare the count with this nurse's MAR and NOT ONE of the meds were administered. The glucometer history did, however, match the MAR.

[fairyluv]

well most of his meds are in liquid form and he gets bolus cans of feeding as well. it really kinda bothers me cause the cna was the one who was telling the DON/ADMIN that this nurse wasn't giving all her meds, so the DON had the CNA place the note there and monitor it. the CNA said it had been there all day until the next shift found it. insinuating that the nurse had not been in that room at all that day. Even if they suspected that the nurse was not giving the meds, why not confront her after the first med pass ?? why let her work the rest of the day and work all day the next day and then fire her once she clocked out ?? really pee poor management as far as I'm concerned and as soon as I can I am hightailing my behind outta there. This kinda booby trappin stuff don't cut it with me. I'm so darn paranoid it's not even funny. I'm really considering going in to another profession, which sad since I've only been a nurse for 6 months. I wanted to be a nurse to help people, but I find it difficult to actually help when I'm constantly looking over my back to make sure there's not someone with a knife ready to jab it in me.

[BrandonLPN, LPN]

Umm, any nurse who feels it's "okay" to skip meds probably won't have a huge moral dilemma about just popping a bunch of pills into the trash to make it look like the meds are passed. Don't underestimate them.

[Melfldrn]

As a new nurse, with 13 years in healthcare as a Medical Assistant, can someone please tell me what would possess ANY nurse to not give meds? The obvious question is why would you want to jeopardize any patient's health...but isn't it pretty clear in this day and age, that you will get caught and you will lose your license?! Then what are you going to do? Because you're definitely not getting a job anywhere ever again, ok well maybe Walmart. This just boggles my mind!