Nurse given anti-HTN & dig, yet documenting bradycardia.

[megananne7]

A friend of mine works in an ALF and says there's a new nurse there that has CONTINUALLY given anti-HTN and dig to some residents and on the MAR will sign she gave it and then document a heart rate less than 60! My friend says she's taken her aside and reminded her of the parameters, yet this continues to happen. I just spoke with my friend and she said this nurse gave metoprolol and then documented a HR of 39!

I asked my friend of the DON knew this was happening. My friend said "I told her people were documenting incorrect things in the chart and she told me "Well just make sure your note is correct". In terms of the "documenting incorrect things in the chart", she's referring to this same nurse who wrote a nurse's note about a patient, writing the pt was on 75mg of something when they were on 50mg, and that the pt was on Darvocet when they are on Percocet.

I told my friend if she didnt feel comfortable going to the state, I would for her, but I figured I would give the DON/Admin a chance to fix the problem. Also, apparently an auditor would be coming in soon to go over the charts. What would you do in this situation?

[UM Review RN, ASN, RN]

My first thought would be for that patient given Metoprolol with a HR of 39.

That's not documenting incorrectly, that's a huge med error and needed to be dealt with immediately. In fact, I'm amazed that no one (your friend who came in after the first nurse gave the med) thought to monitor the patient's HR and BP, and call the doc and report it.

This isn't just a legal issue or a CYA issue, it's a patient safety issue.

PS -- If the patient is getting Dig and is given it with a HR

[Poochee]

If the patient remained stable, would this be an incident report? I think reporting it to the state, is a bit severe, if the patient was not hurt.

I think the nurse should be counseled, on policy and procedure, if, she ends up being written up, part of the write up, should, include completing some CEU's on, digoxin, metropolol, etc.

I think it is common, that in the SNF setting, people just run down the halls, passing pills as quick as possible, maybe even if she assessed the VS, the only rationale, I can conclude, is that she is not familiar with the meds she is passing, especially, if she is a new grad.

Also, some nurses I have seen, have a aversion to calling the doctor, for reasons we all know. She should be counciled, on not ever fearing to call the doctor, or seek help, if in doubt.

This is where her team, comes into place, is your enviroment conducive to asking questions, without being judged and gossiped about.

In summary, no, state does not have to be called, in-servicing by the staff educator- yes, CEU's-yes. Maybe even a probationary period.

HTH.

[megananne7]

In summary, no, state does not have to be called, in-servicing by the staff educator- yes, CEU's-yes. Maybe even a probationary period.HTH.

My issue with the state being involved would be if this CONTINUES and the facility knows about it and refuses to do anything about it.

I will suggest these things to my friend.

[ann945n, RN]

My concern would be not only did she give metoprolol with a heart rate of 39 but even if she didnt know that was dangerous the fact that the heart rate was 39 and she didnt do anything at all with that assessment information!

[VegRN]

Yup, I also think she has no idea what the meds actually do and needs some education on this. I bet she is so frazzled with all of the med passes that she just passes them without thinking. eek

Dangerous, yes but, not sure if the state should be called yet. My impression is that management will not want to provide the education or won't care about her errors until one of the pts gets hurt. If your friend has already told management about the specifics such as the BP of 39 and they do nothing then, I would call the state. If your friend knows about it and does nothing, in the eyes of the state, isn't she culpable as well?

[mom and nurse]

I notice you said that she is a "new nurse". I agree that she is probably just a bit frazzled and needs to know the dangers of giving such medications to a patient with a HR

She should definitely be educated before "something worse" than a low heart rate happens to the patient.