I work in a LTC facility. The other day, during my 5 PM med pass I noted 4 consecutive unmarked days a med had not been signed off. It was not marked as held, resident refused, JUST SIMPLY BLANK.
The med was in the cart, so I then went to the residents chart to note the most recent lab in which this drug would effect. Well, the drug most positively should of been administered. I called the DR. received new orders and completed the necessary paperwork and then turned the information over to my supervisor.
I really have a problem with this. This has happened too many times, and I have went to the DON twice now concerning this. The first time she gave me a little yellow sticky note to place along side the empty slots "nurse's please sign" with her name signed. Well, when the other nurses seen the sticky note, the ones at fault were pretty upset at me for going to the DON.
The second incident , a resident's lab tests showed the med should of been held and the doctor notified. The lab was faxed, however no reply was documented from the doctor and the med was administerd (for 6 days). Thus I called the doctor and received the new order, notified the family, placed the patient on a 72 hour follow up, and completed the paper work. I informed my DON that it has become part of my practise to always check the level of this drug prior to administering due to the errors I have found and asked for an inservice.
The next inservice we had, the DON stated to us, that if a drug is not administered it must be documented "why" and if not the nurse's license may be on the line "NOTHING GOES COMPLETELY UNSIGNED ON THE MAR!". As well as, "nurses you can not just fax, you have to receive a reply, and it needs to be documented that you notified, received the reply and followed the order.
With this most recent error, an RN said to me "Just restart the drug, if we called the doctor on every med error we wouldn't get anything done!" In which my come back was "Noooo, I am informing the DR. ......and ya know if people would do their job correctly, I would be getting a lot more done right now!" Ya know I have a BIG PROBLEM calling a doctor and stating, "the med hasn't been signed off in four days and the last lab results were such and such, and nothing is documented in the nursing notes....."
Nobody can convince me that I am incorrect about feeling this way. And nobody can convince me that I should just overlook such errors. And yes it does take time to complete all the paperwork involved, and no I don't like other nurses being upset with me. BUT.......there is a person on the other side of all of this and is the patient. If we overlook such errors aren't we overlooking the patient entirely. I am not perfect by no means...and I hope I don't come across that way. Errors happen and I know there are many reasons behind such errors. But four days..........................come on now.
Update on benadryl: So I go to work yesterday.......guess what the res benadryl still is not in. I investigate.....fact is.........the pharmacy did send the med the day after I ordered..........however......the nurse on the unit when the pharm tote was delivered never took her med out of the tote........thus....
the med was sent back to the pharmacy. GREAT!!!!!!!!
I report to the DON....she's fit to be tied over it..........I report to the NP...........which says to report to the unit manager.......which was done prior to the DON reporting. Now, we have well over 16 days without the med.
You know you can call anonymously the Ombudsman council in your district or AHCA, you can use your name to the ombudsman only and the ombudsman wouldn't used it without your consent or you don't have to say your a nurse at all, just file the complaint.
I have had many nurses call on med errors. I never says it anonymous only confidential, it give a better appearance to the complaint.
Ask for a nurse ombudsman if they have one. She or he can talk to you privately if you want.
By doing this you can work without your NH knowing it was you, then someone will be accountable for the med errors or any nursing complaints you have. Maybe by AHCA or the council coming in to review the MAR or other records, it will help residents as well as nurses. keep up the good job.
My current job (x 3 yrs) is as a surveyor/consultant for the agency in my state that licenses and regulates hospitals. I can assure you that any state or federal surveyor who finds "holes" in an MAR will assume that the med was not given and write that up as a deficiency in the final report. If it is enough of a pattern or appears to put patients in danger, it could actually get the facility in serious trouble. It doesn't really matter if the med was gone from the drawer, if the Pyxis printout shows the med was signed out of the machine, if the pharmacy records show that the patient was charged for the med, if someone is sure the nurse must have given the med, if the nurse TOLD someone that s/he gave the med. The standard is, IF IT WASN'T SIGNED OFF ON THE MAR, IT WASN'T GIVEN.
Ok- here's a question: if the MAR is unsigned, but the med is removed from the mulit-dose bubble pack from the pharmacy and can visably be seen to be as absent- does this still constitue a med error? I know that if it's not signed, it's considered not done- but if the med is seen to be punched, does this still apply?
That med that's not in it's bubble could be anywhere...in the trash, on the floor, in the nurse's pocket because some crisis came up and she forgot about it. So, no it does not count unless the MAR was signed that it was given.
nurse62
36 Posts
Update on benadryl: So I go to work yesterday.......guess what the res benadryl still is not in. I investigate.....fact is.........the pharmacy did send the med the day after I ordered..........however......the nurse on the unit when the pharm tote was delivered never took her med out of the tote........thus....
the med was sent back to the pharmacy. GREAT!!!!!!!!
I report to the DON....she's fit to be tied over it..........I report to the NP...........which says to report to the unit manager.......which was done prior to the DON reporting. Now, we have well over 16 days without the med.