Residential Medication Error/Refusal Reporting

[AllieEmerson]

I'm not sure if this is the right category for this topic. I recently started as a nurse at a residential facility for youth. They did not have a nurse for quite a while before I started, so I have been doing quite a bit of cleaning up in the medication cart, MAR, etc. I've been implementing new policies and procedures to keep things in compliance and maintain safe and accurate medication administration.

I am unsure how to instruct med aides to document medication refusals. I was always taught (as a hospital nurse) that a refusal is not an error if it is documented properly. Is it sufficient for the med aide to indicate on the MAR that the medication was refused (there is a section on the back to write a reason for refusal). I review the MAR each day and can follow up with children who refuse. Should these be reported as errors? The residential supervisor believes that each refusal should be documented with a "critical incident report" on our electronic charting system. This does not fell right to me. According to our Children's Division Licensing guidelines, critical incident reports are for:

" injury of a child during physical restraint; serious physical or sexual aggression by or toward the child; significant physical injuries requiring medical attention; allegations of sexual abuse; criminal conduct involving the child; elopement; attempted suicide; fire setting; child death; and information which must be reported to the child abuse and neglect hotline pursuant to section 210."

It does not seem correct to document each medication refusal as a "critical incident" based on the criteria above.

What do other residential facilities do to document medication refusals? What about medication errors (I.e. a missed dose)? Do you differentiate between errors and refusals?