MonkeyLPN

Sorry for the original post being a little crazy. I have a lot on my mind because of this situation. I think that putting the flow sheet would be a better way to go about having the PT/INR available to be seen. The flow sheet is in the pt's chart. So unfortunately it is out of site out of mind. Not that there is an excuse for this to have happened. As I was not the only nurse that had given this med to the patient, but as far as I know it is my fault. I will broach having the flow sheet added to the MAR and then having a copy in the chart. The way that this doctor returns labs is by the facility faxing the flow sheet with the lab results. Then the doctor will send back the order changes and the nurse on duty will fill out a T.O. Also I find it funny that the facility did not have me or anyone as far as I know fill out an incident report. In fact the patient was not even notified of the mistakes. It is like there were so many people at fault they didn't want to cause any extra issues. But I am the one that is being monitored now.

It was a PT/INR so it should have been checked the next day by someone that it was followed through, dr, nurse manager, even the nurse who drew the blood. But no one caught it until I did on Sunday. The nurse manager does not do a lot of chart checking unfortunately. Only when the DON is doing chart audits.

I will say that I did make a mistake, but was my mistake a system flaw? We had a new admit on my floor about two weeks ago. When the meds were written in the MAR there was nothing stating that there needed to be a lab draw on the pt 2 days into the stay. Usually on the MAR directly below the med that needs labs drawn will be a date that a lab is drawn and initialed when it was drawn, and also usually there is only 1 person writing dr orders, on this day there was an orientee, a student, nurse manager, and the day nurse, so it was a madhouse that day I do remember. I don't remember receiving any indication that this particular pt had labs drawn on this certain date and I ordered more meds from Pharm, which they sent, which usually they will not do if labs need drawn. FF to Sunday I was looking in the pt chart and found that there were labs that were drawn and that the dr had not signed them. So I took out the labs and asked the oncoming nurse to see what happened cause from what I could figure out is that the day nurse from the day the labs were drawn did not fax the doc the results so there were no dr orders. I know I dropped the ball that day the labs were drawn, I should have been more careful. But I feel like in this particular case even a nurse working there a long time would not have caught this. I do feel like a failure, but I am glad that I also caught this mistake. I am currently having to complete a month of "performance improvement." Which means my nurse manager has to look into my work a little closer and make sure I don't screw up again. Which she admitted that she should have been more specific on the mar in the 1st place and that she doesn't think that this is something that would happen again with me. The facility I am at has also changed the way the MAR will be written out and have more checks and balances especially for meds that require blood draws. I keep trying to remember this particular day as the day nurse SWEARS she told me about the labs, yet did not chart anything about the labs being sent to the dr, which she usually will write at the bottom of the page when she faxed etc. Also the labs were put in the chart without being signed. I would NEVER do that, so who did? Usually the labs stay out of the chart so we know that the doctor has not sent back a signed order, so not to give the med. Also why wasn't this caught by someone, pharmacy, nurse manager, the day nurse? I am PRN nurse and I feel like sometimes I am the scapegoat when things go wrong, although I will accept responsibility for this mistake as I ordered the meds and did not see the labs.

I have the opposite problem. I have 3 aids and love to see them sitting at the nurses station having a good ol' time or "pretending" to chart while call lights are going off, while I am running my tail off with so much work. While I know they have plenty to do. Like maybe get me some vitals. Gotta love LTC.

Run! That is not enough orientation, also that is not a manageable pt load at all for an experienced nurse, not on that shift. Just keep looking.

The lowest GPA I have heard about getting in is a 3.4, but that is the exception. You need at least a 3.7 to be competitive. There are people taking classes three times to get better grades. Which I think is ridiculous, they should move on at a certain point.

The thing about getting the orders clarified is exactly what was not being done by any nurses that have been doing this "online" procedure for a few weeks now. That is why I left the home. The mother and nurse were on board doing this with the pt. They did not see any problems with it. That is where my issue starts. That they thought it was appropriate to do research online about shunts and not being the surgeon that placed the shunt in the first place. So how really would they know what they needed to do, how could they make assumptions about the proper way to care for the patient? I felt that I needed to let the scheduler/supervisor know immediately what was going on as I felt the patient was in need of a supervisor visit from the agency.

At the time that I left the patient was responsive, so it was not a medical emergency. She had been having ICP, but they could not get anyone to see the patient in the area because she is so complicated, medicaid pt, etc. She had the shunt replaced in Jan and the nurse that was orienting me was telling me that the mother looked up the procedure that she was doing up on the internet. I'm sorry but I do not think that at anytime should a nurse be doing anything that the untrained mother looked up online. Also I was not being compensated as I had not agreed to take on this case quite yet, so I do not think that abandonment at all applies. I talked with the scheduler and she said that she was glad that I passed on the info and that she would find me another case. The whole situation made me very uncomfortable. I am not about to do something that would jeopardize my license in anyway as would be the case if I followed this nurse's example. I guess I just learned a little more about HH. I need to ask more questions and see care plans before going into the house. Or I need to find something else to do?

I am new to HH and I know that you need a Dr's order to do anything. My question is a pt today had a VA shunt that from what the nurse who was orienting me said was supposed to have pumped Q2hr. Well she explained that she was told by the pt mother that the shunt was not draining properly and that mother looked up the procedure online and wanted it done a certain way, in other words she told the nurse to pump the shunt a completely different way than how the orders were written, and the nurse was doing it. Now the pt was headed to have a CT scan since she was becoming unresponsive. Since I am new to this agency I told the orienting nurse that I was uncomfortable with this pt and I promptly left the house and called the scheduler and told her the situation. The scheduler then said, well maybe since they are doing the procedure wrong, perhaps that's why the patient is having ICP. Was I right about leaving the home? Any advise?