Med Error by CNA

sjalv · Sep 13, 2015

I really don't understand how an unlicensed person can administer medications legally, no matter whose 'license' you are under. Regardless, no, you cannot be charged with neglect. If you were an RN, negligence perhaps, but provided no serious harm comes to the patient even that wouldn't happen. But if it did, it would fall back on whoever was knowingly allowing you to administer medications in the first place. A part of being a nurse is knowing how to delegate within the person's scope of practice.

TriecyJay · Sep 13, 2015

Thank you. That was honestly my biggest fear. I would like to add in I gave my two-weeks notice prior to this happening and if I got terminated, egally, I will not be paid my 64hrs of unused vacay time on top of my regular scheduled days. Knowing her, the financial benefit of letting me go, would be the real reason why she fires me.

Although it might have cost me my job,, I'm glad I was honest.

Nibbles1 · Sep 13, 2015

I would never delegate any type of medication that has parameters i.e.: Coumadin, diuretics, blood pressure meds, etc... This should fall back on the nurse.

MunoRN, RN · Sep 13, 2015

Having someone take a pill can be two different things; "administering" and "assisting with self-administration." Administering involves interpreting the order, measuring the dose, etc, while assisting with self administration involves helping a patient take a medication that has been dispensed by a pharmacist for that patient and labelled accordingly.

At least in my state, medication administration cannot be delegated to a CNA but CNAs can assist with self administration. What you're describing sounds more like administration, so I'm curious how your supervisor was able to delegate this to you.

ixchel · Sep 13, 2015

These people are crazy if they think firing you is a good idea. A punitive approach to med errors is a good way to make sure no one admits to them. You did do the right thing and I'm sorry these people are jerks.

I also don't think warfarin is an appropriate medication to be delegated. (No offense, I promise!) At the very least, I think I'd take the time to cut the pill for you so I know it's right. I'm a bit OCD, though.

ArlyleRN · Sep 13, 2015

I am a CNA working at a 13-bed Type B Assisted Living facility in TX. I am legally allowed to give medication at this facility, b/c I'm working under my supervisor's license.
I've been working graveyards with this company for almost a yr and a half, where we rarely give PRNs, yet alone routines...
I recently came in and worked a 2-10, gave 5:00 meds and then the time came for my 8:00 meds. When I trained on the med cart, it was with the 8:00 meds, so I felt comfortable with those. Upon looking at the MAR of this particular resident, I then realized I gave 1.5mg over of Warfarin at 5:00. I contacted my supervisor, the POA, and wrote my medication report. The POA praised me for telling the truth and admitted to making the same mistake before. My supervisor informed me on how we would resolve the issue, as in giving a lower dose the next day.
The next day, I found out from a manager designee, the supervisor wants to fire me.
Can she turn me in for neglect??

1. Are you a medication aide? If so, then you are allowed to pass meds. If not, then I am confused.

2. Was the MD notified of the error?

3. The way the issue is to be resolved (giving a lower dose the next day) does not sound ethical or legal.

TriecyJay · Sep 13, 2015

MunoRN, if you look up Texas Type B Assisted Living Facility regulations, you could see how my supervisor is able to delegate such a task. I had a in-house training, took a "written test" and my supervisor signed off saying I could pass meds in the facility under my supervisor's license.

The test consisted of abbreviation meanings and how I would administer different forms of medication, along with the 5/6 rights administering medication.

TriecyJay · Sep 13, 2015

ArlyleRN, I'm not a med aide. My supervisor said she would contact the Dr the next morning. I'm not sure how exactly it sounds illegal or unethical, b/c I honestly don't know.

All I know is that the resident is suppose to have a set mg amount of Warfarin a week. Since I gave1.5mg over, the solution was to give a lower dose the next day to balance out the amount of mg for my mistake...

BuckyBadgerRN, ASN, RN · Sep 13, 2015

Maybe a little OT, but anything happening "under my license" is going to be performed by ME, the one who holds the license!!

vampiregirl, BSN, RN · Sep 13, 2015

I really don't understand how an unlicensed person can administer medications legally, no matter whose 'license' you are under.

Indiana has a curriculum to train staff in group homes and waiver sites to administer medications to the residents of these facilities. I believe it is (or used to be) called "Medication administration in the community". Long before I was a nurse, I worked in a group home and completed this training.

I didn't realize at the time all the implications. And I recall that some of the residents were getting some higher risk psychotropic meds. Now as a nurse I have a completely different perspective and shudder at the thought...

I bet other states have programs that allow unlicensed personnel to pass medications in certain situations with specific training. Hopefully the people who administer medications in these programs ensure that they are following all the appropriate steps, and accessing resources if they ever have questions.

To the OP: Reporting the incorrect dosage to the appropriate person shows your integrity. And as you mentioned in your post, if you are terminated then it probably wasn't even about the med error.

Kooky Korky, BSN, RN · Sep 13, 2015

ArlyleRN, I'm not a med aide. My supervisor said she would contact the Dr the next morning. I'm not sure how exactly it sounds illegal or unethical, b/c I honestly don't know.
All I know is that the resident is suppose to have a set mg amount of Warfarin a week. Since I gave1.5mg over, the solution was to give a lower dose the next day to balance out the amount of mg for my mistake...

MD needed to be notified. If the pt has been on coumadin long-term, I guess notification could have occurred the next day if that is the policy where you work.

As far as firing, if they try to cheat you out of your vacation time, contact the state and/or federal labor board.

Why are you quitting? Did your friend who said they want to fire you say why?

Also, the whole concept of working under someone else's license doesn't wash, I don't think. You should speak with an attorney or 2 or 3 about this concept. Even student nurses who make errors are held responsible, not their teachers. That isn't to say that a serious error won't call the teachers, the school, the hospital, and maybe other people onto the carpet. But the student will have to answer up and bear responsibility for his or her own actions.