Med pass negligence? please feedback

[Kashia, ASN, LVN]

A nurse passes mediations this way:

Takes medication out of drawer or cart.

Verify 5 rights

Signs the medication sheet.

Passes the medication

If pt refuses or does not take, waste or refusal is recorded

and initals are circled indicating pt did not take.

Is this negligent?

I am stunned by my experience.

Agency nurse, travel to different facilities.

This one skilled nursing, been there before.

Approached yesterday by management regarding pm shift Oct 27 5 weeks ago?

patient wrote letter ( she is alert and watches calls state frequently) saying I had not given her BP medication that evening and I had acted unconcerned.

I replyed to admin I do not recall this medication pass but it seems unlike me to treat a patient this way but of course I would go speak with here, which I did.

She said, no you did nothing wrong, it was the nurse after you that told me you had not given me my medication and I should write a letter to nurse manager.

I told managment all is ok, what patient had said to me and I returned to my work.

little while later they approach me to complete an indident report.

I again was agreeable but said I really do not recall this medication pass as I have done hundreds since then but I will fill this out to best of my knowledge.

I looked at medication sheet that date and I had initaled it, which tells me I had given the med and she had taken it.

I wrote incident pretty muchas above with no admission of guilt.

remember I am employed by agency.....so these managers are keeping me past my shift telling me my indident report is not adequate.

I explained how I pass meds..that is when sh... hit the fan. They assumed by my method of passing I had made the error and this became the focus.I had also walked into an office and overheard one of the managers speaking to a staff nurse that was uninvolved in any way how I had made this mistake because of the way I pass meds!!!

It is now 2 1/2 hrs past my shifts end. they are having a private meeting about this , asked me to wait whiich I was trying to be cooperative so I did.

then 2 of managers came out, took me into room to counsel me basically leading to me writing a corrected incident report because obviously I had made the error because of the way I pass meds!

The DON was present at this meeting, I am exhausted and hungery, I saw what they were getting at and stood up saying under my breath as I left the room, this is Bull Sh...

My shift ended at 2:45. At 5:15 I walked out, got into my car and parked called my agency. They were very supportive of me and suggested I call them to come if ever another problem but...this situation left me feeling like I had been interrogated by the FBI and they were wanting me to confess to a crime I did not committ, perhaps to take the heat off them because this patient frequently calls the state.

I have never ever been treated this way or had a situation like this

and still feel overwhelmed by it all.

Sorry I am not whining but this , to me, is an eyeopener as to what can happen in a dysfunctional place.

My employer asked if I would want to have a meeting with them, he would go too, perhaps to sooth things over ( it is their contract) but I declined after sleeping on it. I simply do not trust them. Should I go meet management of facility? Thanks for reading.

[augigi, CNS]

I don't know that I'd say "negligent" in the true definition, but you should administer drugs before signing that you administered them.

[TazziRN, RN]

Never ever chart or sign that something was done before it really is done. What if you sign that you gave a pt his meds, but something happened before you actually made it into the pt's room? Someone comes along after you and thinks the pt got the meds when he didn't.

[TrudyRN]

I think you should chart why the pt did not get the med. Just a "refused" does not tell the whole story and it makes it look like you didn't bother to learn the reason for the refusal. Some refusals need to be told to the doctor.

[HisHands, ASN, RN]

I hope I don't get flamed for this but....

I feel like it's much much worse to have a whole in the MAR than to have a signature.

I've seen loads of nurses not sign their MAR because they got distracted coming BACK from giving that pt the med and never remember to sign. So you are wondering if that pt did or did not get their insulin, etc.

Personally, unless state is there, i do sign out my MAR first. I feel like it gives my pass more flow. I'm not incompetent. I'm not neglegent. I just do this wrong by the states standards. I do the same thing with tx. At the same time, my CNAs know when to and to not interrupt my med pass.

It just works better for me that way.

[HisHands, ASN, RN]

*whole = hole

[mel1977]

I sign my meds before giving, but as I am taking them out of the package, where others will sign them when setting up. I know many places make you take the mar in at the same time, but where I work I am THE med nurse-other nurses only touch my mar when they ask (like they offer to give a PRn for me, or a pt wants their meds first, but are last in line). That sounds bad, what I mean is 90% of the time I am the med nurse on eve shift. I split halls. I don't think it is negligent at all-maybe not in conjuction with policy, but as long as you document that the med was given OR not given,that is the important thing. I have to stay and watch the pt take the medication. On our MAR we have codes and one of them is "C" for patient refused. No explination is needed in according to our policy. Though we do often write it anyway-usually we document the refusal and why they refused on the drs hot sheet. You start writing too much on the MARS and that is a whole different problem. I agree with above that many, more than should be are not signed off-better to sign and give it/or come back with a refusal than to forget and leave-it happens so often and then we can't get ahold of the previous person and there is no way to know if the med was given FOR SURE. We can speculate-it isn't in the drawer, or ask the pt, but heck, they are given so many meds they can't always keep track.

Anyway-I am fine with the way I pass meds-if a upper at work came to me and told me to change, I would but so far no problems.

That isjust my opinion.l

[morte, LPN, LVN]

hmmm that is the way i was taught.....check the mar....take the med out....check again......sign the mar.......if patient declines.....circle my initals and document on the back of mar......it has to be signed (initialed) anyway...so what difference does the order make?

[augigi, CNS]

It concerns me that people adjust their medication practices depending on whether they are told to, or being audited. There is generally a good reason for medication-related policies ie. someone died from missing something that was signed out. Don't forget folks, if something happens and you were not compliant with best practice according to your state, you are in the you-know-what.

[miko014]

We use computer MARs now. So I guess I technically document before I give. I scan the pt, scan the med, scan my badge, save, open meds, and give to pt. If the pt does not take them, I can go back and click "inactivate" and then it takes it off of the MAR and puts it back in the "to do" list. But since I have to scan the pt, and we keep their meds in a locked box in their closets, I am at the bedside when I do it. I usually read them the list of whatever I have to give them and answer questions first. Sometimes they refuse, and I ask why. Sometimes they have a good reason (e.g., I don't want my colace because I have been pooping all day), and sometimes I explain about the med and they decide to take it. Once they tell me everything's okay, then I scan and give the meds.

I can see both sides of the issue here. You shouldn't chart anything until it's done, but with meds, if you forget to chart, that can be dangerous. When I was a tech, 2 RNs had a huge fight because one told the other to go to lunch - she would cover all the fingersticks. So she gave a pt like 4 units of insulin and forgot to chart it. When the other RN came back from lunch, she thought it wasn't done, so she covered him again. I was ticked at RN #2 because I told her "hey, you'd better check with RN #1 before you give that - I'm pretty sure she already covered him." But RN #2 decided that, since it wasn't charted, it wasn't done, and she gave it anyway. RN #1 was pissed because she said, "I told you I would do it! Why didn't you check with me first?" And RN #2 said, "It's my pt! If you're going to do something for someone else's pt, you should chart it!" It was a mess! I'm glad we're going to computers now.

[Drysolong]

I was specifically told by my supervisor to sign the MAR first and go back and circle any medications that resident refused. THEN I was told (during the time State is scheduled) to NOT sign the MAR until the medications had actually been given. I've decided to act as if the State is always there and sign my MAR after I've given the medications.

[P_RN, ADN, RN]

To the OP I'm waiting for the other shoe to drop. Who told you it was negligent?

I like to DOT my med time, take the pills to the patient 5 Rs etc, and then open the package in the presence of the patient and the MAR.

When they're swallowed, then the DOT becomes my initials.

If it's not given, then the DOT becomes a circle is for omitted/held/refused and it's noted in the notes as to why.

MAR, pills, patient all are present together.