Med error questions

[graceyjane]

I am an LPN working in a Skilled Nursing Facility. We have an RN that does not get all the meds on the MAR. When a resident is admitted or readmitted or even with med changes she "forget", "misses" them and they do not make it onto the MAR. One resident didn't get dilantin for 3 days another coumadin for almost a week. These are just 2 examples. I sent the one resident out d/t seizure activity. We then learned that they were on dilantin BID. We had found several of these mistakes on the MAR and brought it to the DON's attention. One other RN was told to "just ignore the error, do not bring it to anyones attention, shut up and fix it on the MAR and to get along". I was told they were not med errors and to drop it! The problem still continues and during my med pass I am constantly going to find a chart to check orders. If new residents come in, readmits or any changes on my MAR I go an recheck and I find errors all the time. This takes a lot of time, but it seems the only way to make sure that I am actually passing the right med and the resident is getting what they need. There are also problems with monthly change overs. One resident was on Novolin 70/30 every AM and PM ever since she was admitted and then all of a sudden 3 months in a row it was not brought over to the new month. I worked the first 2 times during change over and the third time I was off for 2 days and this resident missed her AM and PM doses and they couldn't figure out why her blood sugar was sky high???? Does this happen everywhere? Is this a problem any place else? Any input would be greatly appreciated for this frustrated nurse. Thanks.

[agldragonRN]

wow your floor sounds scary!

those are definitely med errors! you should follow the chain of commands when reporting things like that. report it to your supervisor first then to your don if nothing happens. 11-7 are supposed to do chart checks and should catch those errors.

during monthly change over at my facility, the pos, mars, and tars are checked three times. pharmacy sends the new pos, mars, and tars a week before the current month ends. 11-7 do first checks, 7-3 do second checks, and 3-11 do third checks. we all sign and date the pos so you know who did the checks. if there are orders that were missed, all of us are written up for med error. pharmacy audits our pos, mars, and tars every couple of months and they rarely find missed orders. but it does happen. i work 3-11 so i do the 3rd checks and sometimes i find a lot of missed orders but hey that is why i am there and that rarely happens anyway. my floor is pretty good during pos time.

constantly checking all the charts to check for orders before med pass is time consuming and would be impossible since you have so many residents. i have 25 patients(3-11) and with fsbs and all the bp parameters, and apical pulses for digoxin, it would be very hard to check all the charts to verify the orders. that's the responsibility of the 11-7 at my facility. however, i do check the charts everytime i give the first dose of any meds especially abt because my pt may be allergic to it. i also check the original order for my patients who are on coumadin therapy. those are the only times i check the charts for orders.

well, good luck and i hope your floor gets better.

cheers,

angel

[TheCommuter, BSN, RN]

I am an LPN working in a Skilled Nursing Facility. We have an RN that does not get all the meds on the MAR.

Is the RN the only person allowed to verify orders and enter them onto the MAR when a new resident is being admitted into the facility? At the facilities where I have worked, the person who admits the resident is the same one who verifies the admission orders and prepares the MAR, whether they're an RN or LPN.

These are medication errors. However, I don't think you'll get anywhere by reporting them. At many facilities, especially nursing homes and skilled nursing facilities, they are so hard-up and desperate for staff that management sometimes ignores continual med errors, missed dressing changes, and other things that are not being done. Therefore, it will take a handful of grenades to even get a sloppy nurse to do his/her job properly in these facilities.

You would, however, be doing the correct thing by reporting the medication errors to the facility DON or DNS. If they don't act on your information, you'll know what type of facility you're in.

[graceyjane]

Thanks guys,

Yes I followed my chain of command and the chain of command let me down. I was told they were NOT med errors and to drop the subject. There are so many things wrong at this facility. Nurses drop like flies and they get very frustrated with administration. I am there for my residents, not them. I am their voice, their nurse. I had 32 residents most of the time. My loyalty lies with my residents. This RN still works there and still makes errors. I have no faith in her and always watch my back with her. Always double check. This RN also said she called a Dr to get an order for a resident and when I called the Dr back to tell them the med wasnt working, he told me he had never talked to anyone about this resident. That was one big mess and you should have seen them covering their butts on that one. I had to send the patient out for SOB because the breathing treatments that they were giving her werent working. The nurse before me had charted no SOB for the day shift and all my charting showed she had been SOB and had to be sent out to the ER. So yes I followed my chain of command and that chain is part of the problem. The LPN's are allowed to verify and recheck orders. This RN was the one admitting the residents and she was the one verifying the orders, she just wasnt getting ALL the meds onto the MAR for us to give. I learned really quickly what type of facility that I am in. It saddened me greatly. Thanks for listening, to all who answered.