Med Error by CNA

[TriecyJay]

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??

[NurseSpeedy, ADN, LPN, RN]

Prior to working in an ALF, I did not know that unlicensed staff could literally take an 8 hour 'medication observation' course provided in house, take a test written test in that same facility, and get checked off a few times prior to handing out meds to sometimes 100 or so residents on a given shift....after seeing the results it scared the crap out of me. I once thought that I would rather end up in an ALF if I could not care for myself and that feeling changed because my God I would have a better life expectancy in a nursing home that had actual nurses handing me my meds.

OP, I don't mean any offense to you by what I'm saying. You did a job that you are legally allowed to do and you responded to the error appropriately. Your supervisor is trying to cover her own butt now when dealing with the med error that has occurred. Maybe she didn't contact the MD at the time that you reported the error to her and now she is facing the repercussions for her own actions. The problem is that these facilities are allowed to hire unlicensed staff and delegate them to pass out medications to residents who most likely have a reason why they are not giving themselves their own medications such as they are unsafe to take them on their own. I asked my supervisor if the med techs were responsible for knowing what the medications were and I was told that no, they were not. When the tech had the responsibility to hand out close to 100 sets of meds, I have witnessed shortcuts being taken. One of these short cuts were to give all the PM meds at dinner time...and one of those 10pm meds given at 5pm was the generic form of Ambien...well, at least we knew why the woman got froggy in the evening...

This is a cost cutting move made to eliminate using licensed staff to pass meds in these facilities. Nurses are trained to know the meds, their safe doses, their side effects, etc. Each time a nurse is giving a medication that is listed on the MAR they are going through a process of determining if that medication is safe. In these type of settings, the medication is transcribed by the nurse and then it is not viewed again by licensed staff until either, a) the pharmacy sends the new MAR (well, actually the MOR in an ALF) and the meds are checked with the previous month/recent orders or b) the nurse ends up on the med cart due to staffing issues and ruptures an aneurysm after seeing the crazy things listed and given the past several days/weeks. I had a new med tech that was training with another med tech. In the course of less than 4 hours he had made two mistakes, one minor but still an error, another to the wrong patient (was going by room number (problem number one), went into the wrong room (problem number two), and gave a woman a bunch of meds that were not hers...and some that would never be ordered for a woman (problem number three))...yeah, that was an interesting evening reporting to my supervisor, the POA, and then the doctor. My point is that medications are serious and these issues are happening more often because the facilities are getting cheap and putting profit over safety which is resulting in an increase in med errors that the residents/patients are paying the price for in the end.

[TriecyJay]

NurseSpeedy, Thankyou!! I totally do not feel offended. I see exactly what you're talking about with profit over safety, b/c my supervisor is a greedy one...

I've witnessed exactly that within the 1 1/2yrs I've been employed here. It's sad and I have learned my lesson. I also know the type of RN I NEVER want to be.

[rnforforty]

I'm still confused. It is my understanding that in certain states CNAs, with additional training as a Medication Tech can pass routine meds. Maryland is one such state. Otherwise, anyone other than an RN or LPN, can't pass any meds.

That said, are you saying you gave the patient's 1.5mg dose of coumadin at 5pm instead of 8pm, or, that you gave an ADDITIONAL 1.5mg, or, that the 1.5mg was the wrong dose altogether?

[TriecyJay]

I gave 1.5mg over the ordered dose... I can legally pass meds in a TX Type B Assisted Living facility under my supervisor's license.