I need advice please

[pretty70]

:bluecry1:I work 7-3 shift in LTC. Today I was in the middle of my 9 am meds pass when the supervisor brought me a returned fax from the MD. It was an order to increase Duragesic patch from 25 mcg to 50 mcg every 3 days due to increase of pain.The resident is a 85 years old lady,CMO with a stage 4 open area on her coccyx. I stopped passing meds to take care of the faxed order. I noted that the fax was returned 3/27/09 at 15:37 I was angry and sad because resident's pain med was delayed. When I went to fax the script to the pharmacy I found the supervisor reading magazines. The e-kit in house does not contain 50 mcg patches. I called the MD on call and got an order for D.P. 25 mcg 2 patches 1 time only. I called the supervisor to update him and he did not give very much importance about the delayed attention, but told me that there was not need to call the MD and get the last order. when I gave report to 3-11 nurse she said that the 3-11 supervisor did not find the returned fax last night and resident was not in pain. After I finished given report she went to the dinning room and came back to tell me that there are 2 agitated residents and the activities staff told her that they were agitated all day. I know 3-11 nurse is always trying to get me in trouble. I am off sunday and monday. What should I do? Call the DON on monday or just go to work on tuesday and wait to see what happens. Did I do wrong getting the last order?

[freddiebear]

When it comes to carrying out an MD order related to pain meds i believe that it is time sensitive as in you only have so many hours to admin. The meds.

I see two problems here. The first one is the fact that if a med was ordered and not given in a timely manner that may be a med. error and a report would need to be filled out. You did the correct thing by calling the MD making him aware then taking care of the resident.

You might want to contact the DON about the med error. About a med being ordered and not being administered by a nurse in a timely fashion.

As we are all aware a SNF runs 24 hours a day. If an on coming nurse tells you there are agitated residents and your shift has not ended and you still have the narcotic keys you might be responsible for assessing the residents and documenting on the situation. We all know that we have to try least restrictive measures such as checking to see if the residents are wet, need to be repositioned, or need to go back to bed, it doesnt necessarily mean we need to go and give meds.

[travel50]

Certainly I would let the physician know that the new order was not done timely, but I would not have bothered to call and ask her / him if I could use two 25 mcg patches instead of having 1 50 mcg patch. The 25's were hers. Now if she had a 25 put on day before, there is the question of do you remove the 25 and then put on 50, or just add another 25 now. But if one of my nurses called to ask to use two 25's, my doc probably would have been aggravated. And if a patient was agitated all day, how come no one had told you about it? I'd go with they probably were not so agitated. I've had trouble with my nurses on evenings getting an order off the fax, laying it down and forgetting it. Another nurse will find it a couple of days later. I am frustrated with it b/c it is obviously a med error. So now I make the guilty nurse call the doctor, not the nurse who found it. And good grief! I only wish I had time to sit and read a magazine! I don't hardly have time to sit down (I am the DON).

[ktwlpn, LPN]

We don't accept fax orders-it's a privacy thing according to our admin...Our staff docs are informed from the get-go that this is not acceptable.Once in awhile we'll get a fax from a consulting physician and we have to follow up and obtain a verbal order..We do find labs results shoved in drawers now and then but nothing critical,just borderline..If we need better pain control for a resident we call the doc at that time.The fax is in the supervisors office-no one else has access to it so if she looses something that's on her.Sounds like something like that happened with your supervisors and that's why she got snippy with you about your 2 supposed agitated residents-tit for tat kind of thing.Blow it off....