new charge nurse discovering bad practice on the unit

SCRN1 · Dec 6, 2006

IF she was really told by a patient or their family to give it at an unscheduled time, then she should have called the MD for an order to change the time. This sounds like they were scheduled meds. Unless the doctor ordered them PRN, she had no right to give them at a different time. This, along with not changing the times she gave them, are med errors. An incident report for med errors should be written even if you don't want to write her up in addition to that. But, I would be up front with her and explain what you have to do and give a warning that next time, it will be an incident report and writing her up. If you don't write the incident report and have knowledge of it happening, you are just as guilty.

shiloh11 · Dec 7, 2006

Its pretty tough to prove someone is guilty of something without hard evidence (since she's not charting the early time) even if you know you are right. I would agree that you are probably going to have to do an incident report. I would also discuss it with her privately. Why in the world is she giving the meds so early anyway? How does she justify giving them early (even if it is at the patients request) if they are timed meds?

I do think its important that you set up the "rules" you expect people to go by while you are charge. By no means do I mean that you be a dictator or anything but if you establish right off that you do expect people to follow hospital policy, they should have no excuse for doing their own thing (possibly to the detriment of the patient and the dept).

I hope that helps a little. Its a tough situation that you're in!

SuesquatchRN, BSN, RN · Dec 7, 2006

How does one give HS meds to someone at 2200 when they're sound asleep at 1830? And I had a lot of residents whose HS's were, literally, right after dinner.

Depending on the med and the importance of timing I'd really let it alone if she has to wake everyone up and try to get the meds down their gullets. It just wasn't possible for a lot of my elderly peeps.

mom23RN · Dec 7, 2006

How does one give HS meds to someone at 2200 when they're sound asleep at 1830? And I had a lot of residents whose HS's were, literally, right after dinner.
Depending on the med and the importance of timing I'd really let it alone if she has to wake everyone up and try to get the meds down their gullets. It just wasn't possible for a lot of my elderly peeps.

So do you chart them at 1830 or do you go ahead and put that they were given at 2200 when indeed you gave them at 1830? If you say you're giving them at 1830 then that better be charted that way. :uhoh21:

To the OP, I think you have received some good advice in this post so far. You have to set the tone and letting people slide on med infractions is one you don't want to get "cozy" with. :uhoh3:

SuesquatchRN, BSN, RN · Dec 7, 2006

I never charted meds given unless they were PRNs. Just signed off the MAR. My practice is how everyone dispenses in that particular environment. However, I'm talking LTC, not a hospital.

llg, PhD, RN · Dec 7, 2006

Unless you are absolutely sure that it is your role as charge nurse to handle this situation by yourself, I would seek advice/assistance from your supervisor. Explain the situation and ask them to give you some advice on how to handle it. I assume you are not the only Charge Nurse who works with this other person. Your boss may want to solicit their help in monitoring the situation. Your boss may even want to hang around to observe the behavior herseld.

Purposedly covering up such serious malpractice is the type of thing people get fired for and/or lose their license. I don't think it is the type of thing that a new charge nurse should be handling on her own. Your employer should be assisting you in this situation. If not, you got bigger problems than you know.

Good luck. Let us know how it all works out.

llg

augigi, CNS · Dec 7, 2006

In order to avoid making waves your first week, while covering the liability issue, I would arrange for an inservice on medication administration which is compulsory for all staff. Included in it should be:

- facility policies and procedures

- licensed personnel state requirements

- example of med administration times, and how to get an order changed if it's inconvenient or incorrect

- policy with regard to infringements of the above 2 (incident reports, warnings, write ups etc).

This will let staff know in no uncertain terms where and what the applicable policies are, and what will happen if they do not adhere. After that, write them up to your heart's content.

pagandeva2000, LPN · Dec 7, 2006

I think that the reason this nurse adapted this practice is because she may have worked in places where there was never time to do all of the assignments correctly. Is your unit busy? What is the nurse to patient ratio? I know for a fact that this happens more than we care to admit...I saw it myself as an aide, so, I know that it goes on as a nurse. Speak to her privately and tell her that you are uncomfortable and this isn't the correct way to do this. Only thing is that next time, she may do this when you are not around.

nursindaz · Dec 7, 2006

Yes our unit is busy, but she is a relatively newer RN

Yes, we are a fairly busy floor, although small. We are an acute care/ orthopedic specialty unit. on any given night (3-11pm) we will recieve 5-6 post-op total joints. We generally have three RN's, 2 CNA's and a unit clerk.

Thanks everyone for your input.

P_RN, ADN, RN · Dec 7, 2006

Are they once a day? Did the pharmacy arbitrarily choose 2200? I can see not giving a TID at 1700 when it was just given at 1400, but once a day things why not just ask the pharmacy to change it on the MAR?

I know of plenty RA patients on prednisone who wanted it at 5 AM with an early breakfast so they could be able to move when they got up.

I take all my daily meds at 6PM because I would forget to take them in the AM. Instead of confronting, why not have a group meeting to see if anyone has similar ideas. Nursing is flexible and 2200 is not necessarily set in stone.

allnurses Guide · Dec 7, 2006

Are they once a day? Did the pharmacy arbitrarily choose 2200? I can see not giving a TID at 1700 when it was just given at 1400, but once a day things why not just ask the pharmacy to change it on the MAR?
I know of plenty RA patients on prednisone who wanted it at 5 AM with an early breakfast so they could be able to move when they got up.
I take all my daily meds at 6PM because I would forget to take them in the AM. Instead of confronting, why not have a group meeting to see if anyone has similar ideas. Nursing is flexible and 2200 is not necessarily set in stone.

I like this idea and the one about an inservice about med administration.

It should be easy to change the timing, legally, of a medication if the resident is asleep by the time the med is due.

Skirting the legal rules for time-saving is wrong. If you are short-staffed, then that needs to be addressed. The staff shouldn't be giving meds prior to stated times, and they shouldn't pre-pour.

There were times I had to fill in at our LTC and I would not pre-pour and if the med was late, then I just charted it late and gave the reason why - "not enough staff" :nono:

steph