fangirl

So, there's this patient who during the day is completely and totally independent. Showers self, feeds self, dresses self, walks unassisted, you get the picture. But, at 7pm, they change gears and demand staff to do all ADL'S for them. They will hit the call light to ask you to hold the cup and give them a drink. Demand you walk to the bathroom with them and hold their hand, demand you pull their brief down and pull it up. They will also demand for staff to turn them over in bed. Resident is below 150 pounds and is perfectly capable of turning themselves over. No amputations or fractures and no recent falls. I just don't understand what to make of this, other than that the patient wants attention. Staff has tried everything from encouragement and praise to just doing it all for them. Any ideas?

Update: Leslie is no at the facility.

The narcotics are signed out on the MAR, but not in the narcotic book and the narcotic count is correct. Therefore, they weren't given. If she signed the meds out and the patient refused, the count would be correct or over by one. If a patient refuses a narcotic, you waste it and have another nurse waste it with you and sign it.

When asked, Leslie says, "how did I miss that?" My thought is as you are flipping pages of the MAR, you see a narcotic and think you'll finish popping the other meds out of the cards and then go back, sign the narcotic book and pull your narcotics. Then you get distracted and forget. The facility is a LTC center with a ton of behaviors, frequent fallers, dementia and alzheimers patients. We all have a system for passing meds. Some people check every page and write down medication pass times. Some write down who gets a narcotic, some check their narcotic book after every med pass, some use post it flags, some flag our pages in the MAR book, some put straws in the pages of the MAR. It's whatever works for you. I have suggested we all be given a refresher on medication pass. How to do everything correctly, so it brings it to the front of your mind.

Also, whoever finds it has to call the family.

We do count narcotics each shift. The meds are signed out in the MAR, but not in the narcotic book and the count is corrrect. As an example, Sally is ordered Lortab every six hours routine at 0600 1200 1800 and 0001. I take the keys and count at 0700. When I go to sign out the 1200 dose, I see the 0001 and the 0600 doses aren't signed out. Where I work, medications errors will get you a "learning moment and a plan of improvement". Lately there have been so many that managers have started to give write ups.

Extra doses of psych meds have been found on occasion.

When i go to the narcotic book to sign out the dose I have to give, and I see that the previous dose wasn't given, what am I supposed to do? The responsible thing to do is bring it to a managers attention, which I do. I apologize that it appears I'm on a witch hunt, I am not. I have found my own medication error and brought it to the managers attention.

I work with a nurse, we'll call them Leslie, (not their name btw). This person has had a ton of medication errors, mostly not giving narcotics. We still use the paper sheets for narcotics, not a computer pixys system. The MAR will be signed, but not the narcotic sheet and therefore, if the count is correct, the med wasn't given. I know of at least 19 medication errors in a few months. Myself and others have gone up the chain of command to the director of nursing and administrator. Leslie has had several write ups by their own admission. How many is too many? I'm in no way implying that I am perfect. I have had a medication error or two in my career. Some staff dread seeing Leslie on the hallway, because we can almost bet there will be mistakes. I could totally understand one every now and then as we are all human, but 19? I'm not understanding how Leslie still has a job and a nursing license.

I've been a nurse for almost 2 years and a CNA for 6 years. Med errors do happen. Check your orders, recheck them, then check them again. Med errors happen. The important thing is that if you make a mistake and realize it, tell your supervisors d own your mistake. I've seen several errors and none have caused major harm. The craziest one I've seen was someone getting way too much humalog insulin. If something doesn't seem right about an order, investigate or ask another nurse to look at it with you. It never hurts to double check yourself. Take your time, breath and read carefully. Get in the habit of doing your three checks, before you give a medication. Good luck

We didn't used to get written up unless the error was major or caused harm. Lately, we are short staffed, so more errors, so here come the write ups. Nobody wants to turn in a medication error because of the paperwork and someone will be getting a write up. However, we still turn them in and do the paperwork, but it almost makes you afraid to admit a mistake. I own my mistakes. When I make a mistake, I admit and own it, just tell me how to not do it again, so I learn something. We are all human.

That's the annoying part of where I work. You have to disclose everything. It sucks for building rapport with families. And it's almost always narcotics. I dread hearing the words med error.

The most common are orders that are misinterpreted and transcribed wrong, and people signing out narcotics in the medication administration record, but not in the narcotic book, which means they're not given. We still have paper MARs and paper narcotic sheets.

I completely agree about the paperwork. It is absolutely ridiculous! As an example, if someone has a small scratch, self inflicted, this is what is involved: call family, call doctor, call unit manager, put in treatment order, print Treatment recored, print order, fax pharmacy, make out skin sheet, pain assessment, change of condition skin, Braden scale, investigation and risk management, update the care plan and come up with and implement an intervention. It's ridiculous.