Med Error by CNA

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.

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)

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??

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.

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.

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.

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.

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.

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

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.

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).

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.