Provider X asks LVN to scan the meds X gave

[catsandwich]

I am a clinic RN who handles calls and messages and our Medical Assistants and  LVNs assist the providers in clinic. A newly-hired LVN came to my office with a question at the end of the day because the LVN manager was out. The LVN told me that Provider X instructed the new LVN to scan a medication that the provider had already given (unwitnessed). I don't know that we have a written protocol for this (couldn't find one), so I advised that Provider X, who administered the med, should scan the med. The LVN told the provider what I had advised and the provider was a little upset with me afterwards because apparently the LVNs always scan Provider X's meds for them. My question is, is it safe practice for LVNs to scan medications that they didn't/ wouldn't be allowed to give? Would we need a written protocol first? Just curious. 

 

[Davey Do]

Your perspective is affirmed, catsandwich.

If a med is not administered or witnessed by the individual documenting, then the responsible person is the one who did administer the med.

Also supported is the fact that this is the case- that someone other than the med administrator is allowed to document it as given- then a P&P needs to exist.

Good work!

[missaretha]

>>>My question is, is it safe practice for LVNs to scan medications that they didn't/ wouldn't be allowed to give?<<<

No. Absolutely not.

[JKL33]

Does the provider have the same permissions in the EMR/eMAR and badging system as the nursing staff? If so, then they could indeed scan it. And should. 
 

In the acute cares I've been in where providers did not have those permissions, we handled this situation by scanning the med and making an appropriate notation. "Med reported by Dr X as being administered by him/her at [time].” Or if directly witnessed the statement was just that the med was administered by Dr X. 
 

In my mind there is no realistic legal conflict with these approaches. 
 

This hinges on whether or not the providers at your place are actually able to do this. If not then your priority becomes centered on keeping an accurate medical record of the patient's care—which is the primary function of the EMR. It is also a major safety concern to have medications be undocumented. 

[akulahawkRN, ADN, RN, EMT-P]

Assuming that the Provider does not have the appropriate EMR permissions to scan meds, and in the absence of a P&P to guide me about this, I would also make a comment in the EMR to the effect that a provider advised/reported to me that provider administered the med at the time provider indicated. If I did not witness the administration, I would also add that I did not witness the administration in some manner. If I scan a med that I'm not authorized to administer but I did witness the provider administering it, I will scan the med with a comment that the provider actually administered the med in my presence. As an ED RN, this does occur occasionally when doing conscious sedation procedures. Some meds may ONLY be administered by the provider but the meds are to be scanned by the RN. 

With certain medications that require a witness, sometimes I'll "request" that the provider sign as the witness. This doesn't happen often but the few times it has, I have never had a provider refuse to sign as a med witness for a med that they've administered. While the computer may not recognize them as having med scan privilege, it definitely does as a "witness." Most of the time, I have another RN in room so that RN can sign as "witness" at the actual time a med was administered by the provider. 

[catsandwich]

Thank you! The provider has full access and ability to scan, but I think it's just easier for them to give the med and let someone else do the scanning part. the scanning is being done by an LVN. Medical assistants might be doing it too, but I'm not sure. I was a little leery of the practice just because if in the future there is a dispute, I worry that it's risky for the person scanning the med simply because the record would show that they scanned it in a non-emergent situation - sort of like how we are technically allowed to take verbal orders, but in reality it's highly discouraged in non-emergent situations so we don't make a practice of taking verbals. I might just write up a little protocol, if one doesn't exist, and then we can make sure we're all using best practice.

 

[klone, MSN, RN]

In Epic, there is the capability to indicate that the med was given by a different person. 

[JKL33]

It would be a good idea to get with the medical director and talk it through and decide how the issue will be handled at your place overall. Nursing often perceives this stuff as strictly being about what is "easier" for the provider (or nurses  sometimes assume that they only don't want to do something because it is beneath them)  but it's usually more nuanced than that. 

[catsandwich]

That's a good point.

[subee, MSN, CRNA]

klone said:

In Epic, there is the capability to indicate that the med was given by a different person. 

Then why shouldn't the person who actually administered the drug be responsible for charting it?