Im an (11pm-7am) shift nurse and recently i was called to do 3-11 shift with only 1 day of orientation 3-11pm. I felt confident and had in mind if i followed the 6 rights I wouldn't have problems in med error. As I began med passing for 30 patients, I was falling behind in time before having to start doing FSBS checks and administering insulin. RN supervisor brought the attention to the DON about me med passing late. DON summond me and talk to me about med errors and how soon we are expecting DOH state surveyor. At the time i was passing medications i felt i was going at a pretty good rate. I even pat myself in the back for attempting this even though I went over about 40 mins from the 2 hour window and gave insulin on time. I don't want to loose my license after working very hard in achieving my license for med passing late. I have a couple of questions in regards for being late in med passing.
1.) Could I loose my license if I were to go over the 2 hour med passing window?
2.) Would state surveyor give me a citation if this happened on their watch?
3.) What would be the correct thing to do if i didn't give the medication with in the 2 hour window?
4.) I use electronic BP cuff to speed things up a bit. When DOH ( department of health) is in would it be ok to use the electronic bp machine or should i use manual?
Tip to know for future - just ask the off-going nurse if she knows of any crazy, early times for any particular pts. Same for fingersticks, insulins, whatever. Either she'll be understanding & helpful, or she'll burn in hell.
And if I were feeling esp annoyed, I'd comment that if I hadn't VOLUNTEERED to cover, she'd probably be forced to stay to cover! (Just to make her feel sheepish!)
However, they need to show more gratitude that a NOC nurse came in to do a 3-11 shift. You're not regularly acclimated to doing so.
My thoughts exactly. I started at a new place 2 months ago and worked on my own during day shift (I do 3-11) when a situation arose where they needed someone last minute. I hadn't trained on a day shift in 3 years! I then worked 3 overnight shifts for them before I was technically done with my normal 3-11 training period was done. They were very greatful and said, "Don't worry about it. Thank you so much for coming in." So in your situation, that was sooo not cool of them.
You say you finished med pass to 30 residents on a 3-11 shift in 2 hours and 40 minutes with only ONE day training? You deserve that pat on your back. Job well done. It is very common for even seasoned nurses to be a little late sometimes.
In answer to your question about what you are supposed to do if you have meds to pass but you are passed the 2 hour window: You notify the MD (yes they will be irritated that you paged them for that reason, but if state is watching, too bad. That's YOUR license.) So you notify the MD and find out from them if they want the med held til next dose time or to go ahead and give it. You have to also chart that you gave the med per MD orders or held med per MD orders. But all that being said, that's not a likely scenario to occur when state is there. Like previously mentioned, you suddenly have more nurses on hand while state is in the building. A couple of tips. Plan which meds you will pass while being watched. Pick "easy" ones if you can. Someone with only a few pills or so. Stay clear of eye drops or g-tubes if you can. But if you have to, brush up on the exact proper way. Example; G-tube: with each pill being crushed individually with a 5 ml flush in between each med with a 30 cc flush before and after. Also, check for residual. And check tube placement per your facilities orders. Auscultation to stomach, residual pH....
If you MUST do eye drops in front of someone, brush up on how to do it the "right" way.
The way I see it is the facility can take responsibility for giving you so many patients with b/p, and your work load. You can do the best you can. Some times there is error in the b/p readings, and you have to do it over. It is better to be slow/be safe than make a medication error.
The state has come in and questioned me about my med pass (I am a medication aide) and she asked if I had trouble getting my meds done on time. I told her that I have a lot of patients that are on 15 different medications and they need a b/p check, and to safely and meticulously pull their medications (this is a morning med pass) takes more than the hour after that we are allowed to pass meds. She seemed understanding. So I was honest and said I try my best with as many patients I have. I haven't received any warnings or notices..
If anything, I believe the facility would be in trouble for staffing or for not providing enough staff to safely do a med pass or care for the patients.
The way I see it is the facility can take responsibility for giving you so many patients with b/p, and your work load. You can do the best you can. Some times there is error in the b/p readings, and you have to do it over. It is better to be slow/be safe than make a medication error.
The state has come in and questioned me about my med pass (I am a medication aide) and she asked if I had trouble getting my meds done on time. I told her that I have a lot of patients that are on 15 different medications and they need a b/p check, and to safely and meticulously pull their medications (this is a morning med pass) takes more than the hour after that we are allowed to pass meds. She seemed understanding. So I was honest and said I try my best with as many patients I have. I haven't received any warnings or notices..
If anything, I believe the facility would be in trouble for staffing or for not providing enough staff to safely do a med pass or care for the patients.
I've worked LTC as an RN with 30 residents. MANY with accuchecks, then always needing insulin (takes up a lot of time.)
And sooo many LTC facilities don't care. They say it is due to poor time management putting the blame back on nurses. 30 residents is very typical. Insane, especially with too many high fall risk patients and not enough aides, but typical.
amoLucia
7,736 Posts
Tip to know for future - just ask the off-going nurse if she knows of any crazy, early times for any particular pts. Same for fingersticks, insulins, whatever. Either she'll be understanding & helpful, or she'll burn in hell.
And if I were feeling esp annoyed, I'd comment that if I hadn't VOLUNTEERED to cover, she'd probably be forced to stay to cover! (Just to make her feel sheepish!)