Med errors

[dartnurse]

Last week I was working nights and was cleaning the med room up. I noticed that 3 clients had their meds thrown in the garbage unopened. Numerous other meds were opened and thrown loose into the garbage bag.

The nurse working documented that she had given all these meds except one and documented the pt. refused even with the package of her meds unopened.

The next night a pt. was chanting non stop at 3 in the morning. Becuase of this I looked in the garbage bag and found her meds and others thrown away unopened. Again it was documented that they had taken their meds.

The next shift I was not working but the same nurse again threw 3 pts. meds in the garbage unopened and a lot of crushed meds in the garbage.

These pts have some level of dementia and cognitive impairment.

I reported this to the the administer and director of care.

This nurse is still working on this floor. I was hoping she would be placed on another floor with pts who are cognitive as they would request their meds if not given.

Do family members have the right to know their loved ones didin't get their HS meds 3 nights in a row.

Dilation, Trazadone, Respiradel, Ativan, Serax, and Coumdian were the meds.

Dartnurse

[Darlene K.]

Why do you think she (the nurse) is throwing the patients meds in the garbage? Seems that she not even trying to hide the fact that she's not passing the meds.

[Red Hat Momma]

:angryfire Something needs to be done, reasons explored,etc.,supervisor or DON to work with her. This may be a symptom of an even deeper problem:stone

[matchstickxx]

If this happens again, notify your charge nurse and house supervisor. Ativan and such in the trash can...oh my...I'm sure if anyone is diving in your dumpsters they proably think they hit the jackpot!

Falsifying documentation is inexcusable and, at least in my facility, is grounds for termination.

[fusster]

I wouldn't even wait till next time you see her do it. Patients not getting psych meds is not good for their mental health and not getting coumadin could cause some serious and deadly complications. This is illegal and you have a responsibility to tell your supervisor before something really bad happens to a patient.

[Daytonite, BSN, RN]

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.

[dartnurse]

This has been bothering me because this nurse is still working with Alzheimer's patient's.

I kept these meds in my locker after showing them to the unit manger the first night.

I also left voice mail messages on the DON and administrator's answering machines.

I called and left messages again on the second night also.

2 days later the DON called me in and filled out an medication error form and said this was going to be sent to pharmancy.

Then another nurse found meds again in the garbage as they felt to worried not to look as the same nurse was working.

Again meds were found.

The unit manager was called and also filled out a report and callled the DON.

It was quite unsettling for me when the DON told me that the administrator told her to tell me not to leave those kind of messages on his answering machine to just tell the DON.

2 days efore this we were told the DON was going to spend more time addressing problems on the floor and all disciplinary problems would be addressed by the administrator.

I realize the professional duties of my job not to gossip about this. 6 staff are involved because of being witnessess.

We have spoke discreetly because we are worried and shocked that this nurse is not off with pay pending an investatigation as proctol of the home.

I hope your right and we will have patience and monitor our residents carefully.

Dartnurse

[Daytonite, BSN, RN]

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.)