Med errors

Oh, Lord! I had such deja vu reading your post. We had something similar going on at a nursing home I was working at a couple of years ago. First of all, let me tell you that you shouldn't assume that the DON is not doing anything. This is a very tricky situation because this nurse is probably going to get reported to the state board. The facility has to involve the pharmacy and they have to provide the documented evidence for the facility of what is going on. Your reporting, while it is the right thing to do, is not evidence they can really use by itself. What I would have done was taken the trash bag, closed it and tied it closed, put it in another clean bag for some infection control and had it saved for the DON to observe herself. Don't take them home with you--there must be a place where you can put these bags where they will be locked up and safe until the DON can get them. I would keep retrieving these trash bags with evidence of the disposed meds in them and giving them to the DON until she tells you to stop.

Now, what you have to understand is that these investigations take time. There is also an element of confidentiality involved in this as well. To accuse a nurse of what you suspect her doing can turn into a nasty situation if you don't protect the nurse's confidentiality. This is, after all, partially a personnel issue too. It will drive you up the wall, but hang in there and only communicate with the DON in private about this. Don't gossip about this to any of the other nurses. Do not confront the nurse you suspect doing this. Do not talk about this with any other nurses at the facility. I know that is a very hard thing to do, but you must not blab.

What happened in the case we had was that the pharmacy was consulted. A licensed pharmacist has to look at that trash and identify the pills that are there and make an official statement about them. Because our nurse was just not giving the meds at all (a lot were the Alzheimer's patient's, confused patient's, and gastric tube patient's meds just as in your case) the pharmacy came in just before a night shift this nurse was scheduled to work, whisked the med cart off to a private room and counted every single pill and measured every liquid in that cart, then returned it to the unit before the nurse arrived. Several minutes after she left the facility the next morning, the pharmacy was there to whisk the cart off and count it again. They had all the evidence from that they needed to nail this nurse. I was later told that they had been appalled at the number of medications she had not given! The pharmacy also checked the memories of the glucometer because the nurse was also making up blood sugars rather than actually doing them.

I got so antsy, that I started counting the pills of the patient's I was aware she was not giving meds to and recording my findings every day. I also copied the MARs where she had reported blood sugar results that I could not find in the glucometer. I wrote these up in memos that I gave to the DON and kept copies of for myself. I was fully ready to send all this information with a complaint to the board of nursing myself because I thought the DON wasn't doing anything about this. And then, the defecation hit the ventilation. She was fired and reported to the state board.

I don't envy the position you have been put into. But, please carry through with it. These elderly people need you to advocate on their behalf and this nurse needs to be disciplined. If the DON conducts an investigation with the help of the facility's consulting pharmacy she will be able to remove a bad nurse that has no business working in a nursing home. Good luck, kiddo.

It sounds like your manager is probably working on this problem. I think one of her first calls is to the pharmacy. She has to get them involved from what I know about these things. Also, calling the administrator is not going to be much help to you. The DON is the one who will have to do all the legwork on this--it's within her realm. I know it's the hardest thing in the world to wait around for something to be done! Hang in there. If they want to nail this nurse, the pharmacy will have to come up with some plan with the DON of which many of your staff nurses, unfortunately, will not be involved in. One of these days you will come to work and find this nurse will finally be gone.

When some of us work so hard to get all the medications delivered to the residents it really burns me when someone comes along and nonchalantly just tosses medications away because they're too dog-gone lazy to take a little extra time to see the patient's get them. The fact that they leave huge trails of evidence behind them is always stunning, to me. Since I last posted to this thread I was trying to think back to the nurse I was telling you about. You know, we had problems too with some of the people on Resperidol becoming more belligerant and loud because she wasn't giving it. (Our psych doc loved Resperidol.)