medication mismanagement?

[Eyerly]

Hello All,

This is my very first post! I visit this site often, but have never posted. My situation is this: I worked on a Med/Surg floor at a small hospital. I was assigned to a wound patient that needed a dressing change and orders to pre-medicate before dressing change. His order was for (2) 5/325 hydrocodone. The omni was out of 5/325's so I gave him (1) 10/650 instead. I was fired for medication mismanagement. I have since talked to a few pharmacists that have said this is a perfectly appropriate substitution. Any thought?

[sapphire18]

I'd get chewed out if I called the doctors to ask if it's ok to use 1 4mg vial instead of 2 2mg vials just because the Omni ran out.

Right??!

[bagface]

I'm a nursing student and have noticed our nurses are NOT allowed to do substitutions without a direct order (even if it's like what you described). Although believe me, the nurses are extremely vocal about how angry it makes them, because they legitimately don't have the time to handle things exactly like this and don't feel it's necessary to call someone at absurd times in the morning - I completely agree with them too!

Such a shame. I'm so sorry OP.. I wish you the best in this situation.

[Ginger's Mom, MSN, RN]

There actually is more to the story. In 2003 I hurt my back at work and quickly became dependent of opiates, which led to diversion. After about 3 months I turned myself in to my DON. I voluntarily surrendered my license, completed rehab and was on probation for a year (as well as submitting to random drug testing). I was advised to take a few years off from nursing. I went in to medical sales for about 5 years and, even though the money was great, I missed nursing. During the time that I was in sales I went back to school to become a WOCN. When I interviewed for the postion that I was just fired from, I was totally honest about my past. The CEO told me she would give me a second change. For 2 years, there was not a single problem. I ran my own wound clinic and was very successful at it. When this incident happened with the substitution the CEO told me I blew my second change. The CEO also turned me in to the board of nursing. I have a hearing coming up soon and am just trying to get others' perspective on the situation.

Normally, I would say no problem. Unfortunately with your background, I do not think the CEO had a choice, you know what you did was questionable, sorry, and I agree you should have a lawyer with you.

[wooh, BSN, RN]

When we cannot be allowed to clean an incontinent patient without a doctor's order: "Remove feces from patient's skin surfaces q shift and prn".

Please.

Ummmm, "prn what?" It is not within our scope of practice to just do something prn. We need to be told "prn stool on skin."

This is ridiculous. Even with OP's history. But not surprising, given how stupid administration has decided that they want their nurses to act.

[blondy2061h, MSN, RN]

Our order entry system in the EMR doesn't even allow for number of tabs to be entered. The prescriber enters the dose in the box, with common doses being drop down options. The pharmacy then translates the order to the Pyxis based on what's available there or sends us up an appropriate dose. Some days I'll give 1 16mg pill, others 4 4mg pills on the same patient. With drug shortages, things have varied a lot lately.

[zoidberg, BSN, RN]

i am sure hospital policy can say and do what it wants, but pharmacy law in my state (one of the most strict practice acts in the US) allows me to change out any form of med, even half tabs, if the dose is the same for the patient. I choose not to do this for adderall... but we can, and I do it for pain meds for my pt's. sometimes you have to get creative so people dont have to wait for their meds!

[LightMyFire]

At my facility all we'd have to do is call the pharmacy and they would change what we could pull. I've had to do this numerous times with Toradol specifically. The pharmacy is a valuable resource. Often they will call the doc to clarify med orders so you font have to. Keep this in mind the next time you're in a similar situation.

[BrandonLPN, LPN]

If the BON of whatever state the OP's in rules this as a "medication error".... then they don't deserve the power entrusted to them.

Maybe the OP violated some sort of hospital policy. Hospitals frequently make stupid policies. But giving the right dose of the right med by the right route to the right pt at the right time is NOT a med error. I don't recall "right number of tabs" being one of the 5 rights of medication administration.

[TheCommuter, BSN, RN]

I agree that no medication error was committed. But keep in mind that the OP's employment was not terminated for a medication error. Rather, he/she was terminated for the more liberal offense of 'medication mismanagement.'

[BrandonLPN, LPN]

I agree that the facility was within their rights to enforce their policy. However silly this policy may seem.

But what possible interest could the BON have in this incident? (provided there isn't more to the story)

[mlbluvr]

I was fired once for suggesting that since I worked night shift, and night shift charted in red ink, and that other than work I'd never use red ink- so maybe the facility should buy my red pens? To top it off, I was just being facetious. Canned. Got unemployment for a few days, just to have my termination officially declared unjustified (funny, how in nursing, you really can't seem to count on an accurate evaluation from a former employer? Prior to the 'pen' incident, a week prior, I was given a raise and told "We're so glad you're part of our little family").

[applewhitern, BSN, RN]

Wow. Talk about the "dumbing down of nursing." I am flabbergasted that you can't simply give the exact same dosage in this manner. No wonder people say a robot can do our job.