Alright, I'm a third year student and it has always been consistent on my part that whenever I need to give a narcotic to a patient I must do the following:
1) Assess pain and rate to determine dosage strength
2) Look at the prescription order
3) Check the MAR for last dosage given
4) Have another nurse co-sign a draw
5) Write down on the medication log and room number on top to who you're giving it to
6) Then after administration, I would log it as "AD" in the MAR.
This is how I was taught and is the correct way... presumably.
However, it just seems that every nurse in the units I have clinical at, they would always log off the narcotic BEFORE administering the drug. They always say, "Well what if another nurse administered the drug to that patient, and you administered your drug to later come back to log off your med to see that it was already given. You double dosed the patient."
Well first of all, only the students seem to be even writing on the medication log properly and writing the room number on top. A double dosage is unlikely to occur because it's my patient and if another nurse wanted to give a narcotic; they'd have to go through me first (at least thats what I'd think). Also writing the room number on the log book will tell you which rooms were given narcotics... if you see your room number, then you'd immediately check up on it. Also, what if the patient refused the narcotic medication after agreeing to it (which has happened to me 4 times w/ confused pts.) prior to administration.... you can't simply delete "AD" without valid reason.
What do you guys think? Nurses on my unit kind of despise the students because we refuse to do the ways they do it, among other things.
I mean this is kinda stupid. Look at the MAR before to see when its administered(so you don't double dose) and then document it after they take it. This is not rocket science. Both are easy to do. That is essentially how things work in electronic charting. Scan the med (which equates to looking up the last administration), and then signing off (which actually logs that you gave it).
BScN. Are you Canadian? This might be where some of the miscommunication between you and Heather is coming from. I know Canada has 4 year Bacc programs that have clinical throughout the whole 4 years. So third year student would have quite a bit of clinical under their belt. In the US, whether you are ADN or BSN you have a couple years of pre reqs (the BSN has more than the ADN) and then generally 2 years of core program. This would mean a "3rd" year student hear would either be in the first or second clinical semester of a program. There are some 4 year programs that have nursing classes and clinical starting before the "3rd" year, but it is not very common anymore.
The US/Canada difference could also be why it is so "shocking" that you have a paper MAR since that is going the way of the dinosaur her in the US.
It sounds like you already know not to confront the staff nurses due to being a guest of the facility there to learn. But to answer your actual question, yes it is quite common to see nurses admin meds different then how we are taught in school. I see nurse waste narcs and get witness signatures without actually being witnesses. I have seen nurses pull and chart meds for multiple patients at the same time, then put them in bags or cups and administer without scanning to verify.
I think one this that may be different, or maybe you haven't touched on it is that once a med is pulled, it is pulled. You can't just put it back and strikethrough on the MAR unless it was individually packaged. Are these nurses popping the pill out an then attempting to pass, or are they leaving them in the package while pre charting. There would be a different reason for pre charting in both of those instances and different ways to correct the count when returning or wasting the med. I think a lot of it comes down to speed. The nurses have a lot of responsibility and a lot required of them. The pre charting probably shaves off minutes that allow them to pee once a shift or eat lunch real fast or whatever. If you don't agree with it, unless a patient is harmed then just let be. You can only control your practice and when you are a nurse, you can do it by the books.
Yeah I'm taking the BScN here in Canada. We do have clinicals all throughout 4 years combined with core subjects within the first two years. We don't do any paper charting in terms of medications; we actually call it "VAX" here which is the computer program to log off meds on the computer. But we also do paper charting in addition to electronic charting for narcotics.
Oh'Ello, BSN, RN
226 Posts
I mean this is kinda stupid. Look at the MAR before to see when its administered(so you don't double dose) and then document it after they take it. This is not rocket science. Both are easy to do. That is essentially how things work in electronic charting. Scan the med (which equates to looking up the last administration), and then signing off (which actually logs that you gave it).