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

Specialties Geriatric

Published

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 ??

It is not at all hard to get away with in long term care. Just don't do the same ones every day.

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!
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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!

Time constraints, pressure to get through the day, laziness? I've known a few or more nurses also that will do anything to avoid doing what they are supposed to. Like Brandon- take the pills out, throw them in the trash. Spending the same amount of time trying to avoid work, then the time it would take to DO the work? A really stupid one, though- signing off treatments in the book, and not doing them, knowing the old dressings were dated? Waiting 15 minutes for a CNA to change a poopy diaper so you can do a tx,. when you could have changed the diaper, and done the tx., in a total of 5 minutes? And even better? Those chronic troublemakers who spend more time trying to get other people in trouble, than they spend doing their own work? Theres a couple of THEM in every SNF, yes?

Fact is, though- for every new trick a nurse figures out how to not give a med, etc., there's always a new trick to find them OUT. Without posting notes on patients.

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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."

Wow. So now we're going to purposefully create a scenario where a resident is likely to miss a needed med in an attempt to catch a nurse in a "gothca" trap??

That's even worse than the post-it note on the belly of the PEG tube resident.

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Only likely to miss a med if the nurse is the type not to give them in the first place. And if she is, she's not going to give it anyway. Real fast way to find out. And besides, the average nursing home cart is probably missing 20 meds as it is because they are not re-ordered. Gotta fight fire with...FIRE. Another way is just to call the pharmacy, on one patient's med profile, and get a copy of all the deliveries for any set month- you'll be able to tell real quick if meds are being given, because if they are being delivered- they AREN'T being given. Like I said, there's always another way to do your detective work. If I were DON, I sure wouldn't wait for survey time to discover such issues were going on.

As an aside- long ago in another state, the Medicaid people came every three months, and scanned all the MARs for the time period. For every single empty box, the SNF had to pay for that medication for those three months. You can bet the place didn't suffer very many unsigned meds?

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A facility I worked in dated every first pill popped out of the card. If say, seven days later, there were only 5 pills popped out, somebody wasn't giving them. We also dated and timed every single ABO pill popped, proving the med was at least pulled.

This isn't any proof the meds were given, but it is proof it was as least popped out.

The stupid part was some nurses still didn't give some of the meds, even though they knew they were dated. Common sense is apparently not a requirement for licensure.

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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?

Agreed!

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Specializes in Pedi.
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.

So who's to say the CNA didn't remove the note and give it to the next shift to turn in to management? Or whether or not she ever placed it in the first place? I don't really think that this little experiment proves anything. It's not always necessary to lift a patient's gown to get to a PEG tube.

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Specializes in being a Credible Source.
I'm really considering going in to another profession... when I'm constantly looking over my back to make sure there's not someone with a knife ready to jab it in me.
This behavior is neither endemic to nursing nor unique to nursing.
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At my facility we use bingo cards for our meds and we were having people initial and date next to the med they popped for a while. We also use paper MARs and would record the number of doses left on inhalers. Seems to work pretty well.

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Specializes in orthopedic/trauma, Informatics, diabetes.

I worked LTC for a while and I agree that they need to get computerized. There were protocols in place for controlled meds: counts, wastes, documentation for both. For the "regular meds, there was no documentation for dropped pills, borrowed pills (which is wrong anyway). I had a pt that was supposed to get a suppository every morning. I gave it, but the count never changed from the morning. There was a nurse that would not do suppositories or eye drops. But documented that she did. I brought it up every time w/supervisor. Nothing was ever done. Glad I am at a hosp now where everything is computerized.

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Specializes in Emergency Department.

You can put all of the systems in place to monitor whether or not a medication has been drawn up, punched out, push out, scanned, and all of that stuff. It does not mean that the human at the end of the equation is still actually giving a medication to the patient. All of those systems only deal with accountability up to the point before where the patient is actually given the medication. Even with the newer computerized systems, you can have all your medications scanned and you can even scan the patient, "accept" the administration of the medication, and dump the medications in the trash.

With that kind of deal going on, your medication count would be correct, the MAR would be updated correctly, everything would look exactly as if the patient had actually gotten the medication. The only way that it could be proven that a patient is actually not getting the medications would be if there were lab values associated with those medications that could be referenced against, or someone competent was able to actually witness the medications not being given.

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Specializes in Hospice / Psych / RNAC.
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.

Amen!

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