Misconduct

[Abbycat]

Has anyone ever heard of a nurse being terminated for gross misconduct after accidentally omitting an entry when transcribing MARs from one month to the next?

[morte, LPN, LVN]

This singes my shorts also, meanmaryjean.

Just last weekend, I put in home meds Rx by the MD for Namenda 5mg HS. Pharmacy wanted verification for the med, as Namenda is usually given BID. So, until the MD clarified the med, pharmacy refused to dispense it. So instead of getting a single dose of Namenda at HS, the patient got none.

Where is the sense in that? There are other examples. I think WRMC's pharmacists are phacist. Or Fascist.

pharmacist practicing medicine? perhaps a complaint to the pharmacy board is in order? I am thinking of that with LTC's most "favorite" pharmacy provider over certain idiot things they are doing lately.

[CharleeFoxtrot, BSN, RN]

To the OP, was there no second check on the MAR? When I worked briefly in SNF that had paper, a second nurse had to look over each MAR at changeover and compare them.

[SpankedInPittsburgh, DNP, RN]

"Gross Misconduct" does not mean you made a simple mistake. We all make simple mistakes and unless they can prove more than that you should get your unemployment benefits. Appeal this as its nonsense. These cheap bums just don't want their unemployment insurance premiums to go up. When you get your unemployment stay on it as long as practicable so their rates do go up and use the time to find a job that really fits you. Thirty-five years of doing this job should be rewarded with more than a swift kick in the pants.

[hppygr8ful, ASN, RN, EMT-I]

The MARS come from the pharmacy but were incredibly inaccurate every month. New orders were never on the MARS- it took a couple months or more. I accidentally omitted a seizure medication and consequently the medication was not given. The pt had a seizure after not receiving the medication for approximately 10 days. He was treated in the ER, given a loading dose of Depakene, treated and released. I had never received any kind of disciplinary action prior to this. It was simply human error. I've been a nurse for 35 years and never had any issue like this in 35 years.

This is exactly why I carry a personal malpractice insurance!

Hppy

[lifelearningrn, BSN, RN]

Do you have malpractice insurance? If so, please contact them ASAP. If this company is willing to throw you under the bus with unemployment, they will (or already have) report you to the BON as well. I agree with others this isn't gross misconduct but human error.

[NutmeggeRN, BSN]

my heavens, who is still using paper?

Lots of us in LTC

[mudd68]

Sorry this happened to you Abbycat! I'm a firm believer that the nursing staff is 9/10 times the secondary victim to the situations we are placed to work in and the first to be thrown under the proverbial bus when said processes and situations ultimately fail (a main contributing factor in why I no longer practice bedside nursing). Anyhow, during my LTC days, the first couple of med passes on the month - I took both the prior month MAR and current MAR in the event a transcription error occurred. Best of luck in winning your appeal.

[Davey Do]

This is exactly why I carry a personal malpractice insurance!

Hppy

Yeah. My nursing Liability Insurance advised me how to deal with a situation at a community mental health clinic when a coworker gave a client sample meds without a doctor's prescription.

The coworker got fired over the incident, and two weeks later I was fired for "not meeting job expectations".

I got a big severance package out of that deal. I contested the denial from unemployment and won. So, I took seven weeks off, went on a trip, and was hired at another mental health clinic as an administrator, making eight thousand more a year.

Some things do come out in the wash!

[amoLucia]

PP CoffeeRTC has explained the montly rollover MAR for NH/LTC facilities well. But we need to add to that explanation a timeline that is inherent in the process.

When it prints the new MARs, the Pharmacy will add, change and/or delete all orders that it has received up until a predetermined date. (for example, let's use the 20th/21st). Everything has usually been caught' up until that date.

Then it starts printing everything out.

New printouts are then sent out to the NH/LTC prob around the 24th of the month. It sits there until some nurse on a 11-7 shift MANUALLY tears them all apart and arranges all the 'pieces' to be reviewed (the MAR & TAR, the MD orders, and any 'special' pages like psych monitoring, tube feed sheets, etc.

So the LIMBO period for the new paperwork is from the 20th/21st forward. And remember, that this is an expected task IN ADDITION TO the nurses' regular tasks. And agency nurses freq DO NOT touch the recaps/rollovers. Sometimes unexpected errors occur that can eat up a whole day or two. The 'short' months makes a difference, too.

And then another critical period is when a NOC nurse has 'checked out & finished' the next MAR, and then a new, NEW order is obtained and NO ONE corrects the new month's paperwork sitting on the desk.

Sometimes, a NH is blessed when admin will staff with a 'Recap" nurse for a day just to do the rollovers. But the system is still fraught with room for potential errors.

Hospital staff have little idea how 'dark ages' NHs can be and that it's a miracle that more errors are not made.

[Abbycat]

I haven't been at this place for 35 years. I've been a nurse for 35 years.

[Tenebrae, BSN, RN]

Why is a nurse transcribing the MAR?

Surely that should be the responsibility of the doctor or nurse prescriber

[Davey Do]

Why is a nurse transcribing the MAR?

Surely that should be the responsibility of the doctor or nurse prescriber

It has been 30 years since I transcribed MARs when I worked at Weed Rover Township Hospital, but if memory serves me right, they were basically done every 2 weeks.

The MN RN would transfer ongoing meds from the old MAR to a new one. If a med was ordered for a specific duration, the RN would note that also.

Here is an example: