Med Error by CNA

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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??

Specializes in Critical Care.
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.

That's part of what's confusing because I did look it up and it appears that medication administration is not included in a Type B facility, only medication assistance. Are giving medications by taking medication out of a bottled labelled with the patient's name, directions of how many to take, etc, or are you looking at a physicians order and taking from a supply of the med?

I'm also not sure why you think this falls on you, if you truly working under someone else's license, that means any mistake you make is by definition their responsibility.

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MunoRN, according to DADS, subchapter C, under medication... "an employee of the facility to whom the administration of medication has been delegated by a registered nurse, who has trained them to administer medications or verified their training. The delegation of the administration of medication is governed by 22 TAC Chapter 225 (concerning RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions), which implements the Nursing Practice Act.

Kooky Korky, I'm accepting a job with the state as a CO to be able to afford nursing school. Then work on the medical side of Corrections, once I graduate.

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Specializes in Pediatric Critical Care.

I, too, looked it up and it appears correct that an unlicensed personnel is able to administer meds in this setting, including measuring out a liquid dose or breaking a tablet for administration, as long as an RN has "calculated" the dose prior.

It appears legal, and I must say that I am shocked that it is.

(see section j)

(and also #5 here)

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There's the catch... She was not physically there to calculate the dose...

My next question is, I am still actively working here and have not been suspended... Can she legally fire me after so many days of me actively working since the incident??

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I have learned not to trust anyone in 'Assisted Living', administration, CNA's, nurses. Sometimes these administrators are former Walgreens managers and the like. You can't trust administration, management, and a lot of nurses even in LTC facilities. One day they are your friend and the next day they want to fire you.

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Specializes in Critical Care, Education.

Sorry to say, but there really are no legal barriers to being fired if you're not protected under a union agreement. So - yes, OP can be fired. But everyone also has the right to pursue legal action if he/she feels that the termination was unjust. IMO, that would take a lot of resources & "the juice may not be worth the squeeze" in terms of what you'd get for your trouble and expense.

I have always felt that this particular area of nursing practice was too fuzzy -

Tx Administrative Code 225.4 RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS Definitions: (2) Administration of Medications--removal of an individual/unit dose from a previously dispensed, properly labeled container; verifying it with the medication order; giving the correct medication and the correct dose to the proper client at the proper time by the proper route; and accurately recording the time and dose given.

As you can see, the definition is specific for unit dose - so if OP had to break tablets, this is outside the rules of acceptable practice.

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HouTX, yes ma'am, I would've had to cut the pill, b/c the pill wasn't pre-cut already...

I've been praying about it and I'm not going to stress behind it either... I have until the 26th, which is my last day of employment, to honor my two week notice.

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I wouldn't worry about them turning you in. They should be worried about you turning them in. I don't know of anyplace in this country where a CNA can pass medications. If the nursing director was "letting you" work under her license, then you should report her for allowing an unlicensed employee administer meds. I'm sure the reason for that is because they don't want to hire a licensed nurse & pay that salary. It's cheaper to hire a CNA & tell them it's okay to give out meds.

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Specializes in critical care.
I wouldn't worry about them turning you in. They should be worried about you turning them in. I don't know of anyplace in this country where a CNA can pass medications. If the nursing director was "letting you" work under her license, then you should report her for allowing an unlicensed employee administer meds. I'm sure the reason for that is because they don't want to hire a licensed nurse & pay that salary. It's cheaper to hire a CNA & tell them it's okay to give out meds.

This has been addressed more than once in this thread and the literal letter of the law in OP's state is posted two posts above yours. Some states allow UAP to administer medications.

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Nurse Diane, I'm legally allowed to give meds, not cut them.

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Specializes in Rehab, acute/critical care.

I'm glad that you reported the med error, that's the right thing to do. I'm sure you learned from it and will be more cautious next time. Unfortunately making med errors is eventually going to happen to anyone who administers medications, what's important is that you caught it and told the appropriate people. Don't trust what the "grapevine" says. I don't like when people will feel threatened of losing their job over one med error (and patient is ok), I can understand if it is a constant thing but everyone makes mistakes. If the MD is notified they will probably monitor the patient and PT/INR for any changes.

I was once offered a job at an assisted living facility and was surprised that the CNA's passed meds as well but it was all meds the patients would have been taking themselves at home.

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Specializes in Pediatric Critical Care.

I have always felt that this particular area of nursing practice was too fuzzy -

Tx Administrative Code 225.4 RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS Definitions: (2) Administration of Medications--removal of an individual/unit dose from a previously dispensed, properly labeled container; verifying it with the medication order; giving the correct medication and the correct dose to the proper client at the proper time by the proper route; and accurately recording the time and dose given.

As you can see, the definition is specific for unit dose - so if OP had to break tablets, this is outside the rules of acceptable practice.

There's the catch... She was not physically there to calculate the dose...

The OP is allowed to break tablets. The exception to the rule is that the nurse has to first calculate the dose, and then you can prepare the pill or draw up the liquid in a syringe. I don't take the links I posted above to mean that the nurse has to calculate it anew every day.....just that the nurse has to have gone through the process of "A pill is 50mg and the patient gets 25mg. One half of a tablet should be given." And then you give 1/2 tablet. I would think that the instructions for you would need to be given like that, i.e. give 25mg (1/2 tablet).

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