Published Apr 10, 2014
I'm in RN school and work part-time at night at a nursing home. Last week I had a new resident who had requested to have ONE norco. His order was for two. Since he requested one though, that is what I gave him. I put it on the mar that he had one per his request, I put it in my taped report, signed off one narcotic in the narc book. I did was I was supposed to. However, the day nurse threw a fit that I didn't punch out two pills and dispose of the other and basically said I should have made the guy take two.
Well, you need TWO nurses to dispose of a narcotic at my workplace, so when I work at night and I'm the only nurse for all 45 residents, I can't exactly dispose of narcotics. I asked another nurse with more experience and she told me that flushing the extra pill was not their policy and it is wasteful.
Anyway, I evidently got a med error for this because his order was for two tabs q6 hours PRN. I thought I did everything right when he requested only one, gave him one, punched out one pill, and charted that he request only one, but the day nurse felt otherwise. I'm frustrated by this because I don't think it was something that should be considered an error. My DON told me so long as I chart it was his request, it's ok to give LESS of a med, but not more. Which is what I did. She said she wasn't going to put the med error in the med error log, but rather in the man's history and she added a note that it was per his request.
I'm concerned that I have a med error in my history now. Does this go on some kind of record? If it wasn't put in the log did I even get a med error? Was this even a situation that was considered a med error? I could use some insight.
Okami_CCRN, BSN, RN
Okay this is a little sticky, what did the order say?
if the order read administer percocet 10/650 and it came in 5/325 and you only gave one then yes that's a med error. If the order read administer percocet 5/325 for pain of 1-3/10 and 10/650 for 4-6/10 then you were fine. An order should never read administer percocet 2 tabs... whats the dosage? While its not a med error that caused harm it was not what was ordered if that makes sense.
I believe it was Hydrocodone APAP 5/325 tabs po 2 tabs q6hr PRN for moderate pain. So each pill was 5/325 and he would get 10/650 total. However, if he quested to only have one instead of two, I guess I just see that as doing what the resident had requested since he had the right to refuse taking two tabs. I had charted and reported off that he requested one instead of the ordered 2 tabs.
Then I don't see that as a medication error, the patient requested one tablet and using your nursing judgement you agreed. I do not see the day nurse took it that far.
TheCommuter, BSN, RN
Yes, unfortunately, this is a medication error. The order called for two tabs, but only one tab was given per the patient's request.
The next time a patient requests one tablet when two have been ordered, you call the doctor and get the order changed to read "1 or 2 tabs." As long as the physician is aware and the order was changed, your butt is covered.
Nursing is more clerical than many people realize. Always cover your behind.
I can see it both ways... It's really sticky situation. Completely agree with Commuter. Nursing involves a lot of clerical, technical stuff...
For pain med orders, it is best to obtain the order according to severity. For example, 1 tab for mild pain (1-3), 2 tabs for moderate pain (4.6) etc. Something like that.
CrunchRN, ADN, RN
Technically yes, but understandable. It should not be anything to follow you around. People, even nurses, make errors and that one was totally harmless.
SopranoKris, MSN, RN, NP
To me, since it's a PRN order, it does not constitute a med error. Patients have the right to say they'd like less pain meds and she charted accordingly. Personally, I feel the day nurse is getting her panties in a wad over semantics. Just my 2 cents.
classicdame, MSN, EdD
I would consider your action as allowing the patient autonomy in his own care. In our hospital we document "refused" and no one argues it, even the MD. If the patient continues to refuse, then the patient and the MD need to determine if a change is needed in the order. Thanks for looking out for your patient.
psu_213, BSN, RN
Technically speaking, yes this was a med error. However, I for one, think you handled it correctly. If you followed the other nurse's advice, here are the options: (1) you force the resident to take 2 pills when he only wants 1, (2) you lie, throw the 2nd pill away and just give him one, (3) you call the doc in the middle of the night over what the doctor will see as a very trivial issue, or (4) you force the resident to sit in pain if he refuses to take 2 Norcos.
Considering there was no harm to the resident and you were honoring his rights, I wouldn't worry too much about it following you around "in your record."
SoldierNurse22, BSN, RN
If that's a med error, then there goes that warm, fuzzy feeling I was getting about nursing and autonomy.
The patient wants half their dose. The nurse provides it for them. And somehow, that's an error? Let's not talk about nursing judgment, patient involvement in their care or the spirit of the order. If what you did was wrong, OP, then someone should probably put us both out of our misery.
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