Should I back off?

[jschut, BSN, RN]

Problem:

Computer order states:

2 tabs PO Q HS

Paper MAR states the same.

The nurse that passes PM meds gives this medication, signs her name to the narcotic count sheet, but doesn't sign it on the MAR. Then when the next nurse comes on duty, she does not realize this med has been given, so gives it again. CAusing the client to receive pain medication in double the dose a few short hours apart.

This behavior has been reported 4 times that I know of, the DON has spoken to her, and the nurse in question says she is going to contact the doctor and have the order changed. (She's a rather pushy nurse who likes things her way).

As of last night, she changed the MAR to read 2 tabs at PM and HS PRN pain, and told the oncoming the order had been changed. Come this morning, order was checked and compared with computer... order not changed. Continued to read as always... 2 tabs PO Q HS

Med error written up again, and turned in.

Here's another issue. The nurse that constantly gets caught in this mess is me. I have only been at my job 2 months, and the day shift nurse does what she chooses when she chooses. I have reported this to other nurses who were training me at the time, they wrote it up as a med error, and since then, I have caught it 3 more times, the latest being this morning.

I'm afraid I'm stirring the pot, but I don't feel med errors should just be let go like this. Especially when it involves a narcotic pain medication.

Am I pushing too hard? My husband tells me to watch my back..... that I'm making enemies. But I really like my job. Should I back off and go with the flow? or continue to do what I feel is right?

[sweetiepeas]

We as nurses are the patients advocate. I would take it higher if need be. There is no excuse for that kind of behavior.

[caliotter3]

Your husband is right, you are making at least one enemy and you should watch your back. However, you are right. Your's is a dilemma many nurses, both new and experienced, face on a daily basis. Were it feasible to discuss and resolve the issues with the persons concerned, there would be far less behind the scenes drama in the workplace and the work would be accomplished in a more efficient and error-free manner. My advice is to watch your back.

[systoly]

Sounds like you're dealing with a renegade (contrary to the TV show with the same titile, this is not a good thing), however, if the patient indeed benefits from the extra dose why not go ahead and get the blessings from the doctor. As far as other instances are concerned, it sounds like enough reports have been filed and DON or mgmt. chooses to ignore them. I'd back off at this time, but get out of the victim frame of mind. You are not caught up in the middle of anything. You administered and signed the MAR and the narc sheet for a certain Rx, the same Rx was signed out on the narc sheet by someone else which points to diverting rather than a med error, because the MAR was not signed. How do you know that the other nurse administered the med? If she personally says so I would ask her to sign the MAR or make a narrative entry.

[leslie :-D]

i guess i'm not understanding the errors...

can't you tell when the med was given, according to the time stated in the narc book?

leslie

[jschut, BSN, RN]

Isn't it still considered a reportable medication error when a med is given out of the allotted time frame?

[caliotter3]

Isn't it still considered a reportable medication error when a med is given out of the allotted time frame?

I would think so unless it is a PRN administration.

[Meriwhen, ASN, BSN, MSN, RN]

Isn't it still considered a reportable medication error when a med is given out of the allotted time frame?

Technically: yes, it is. Giving a medication out of the time frame is an error.

Reality: being 3 minutes late with a Baclofen is (IMO) not something worth reporting.

Seriously though...providing it's not a PRN medication, consider the medication as well as how off-time the administration is. Missing the window by a few minutes for most (not all) medications isn't horrible--in fact, many nurses here here have probably done it. Days are busy, emergencies happen, and sometimes the med pass ends up a couple of minutes late. That doesn't mean it should become a regular practice though.

But if you are talking being more than an hour late (or early) with medications, messing with medications such as insulin where it really has to be given when scheduled, or--as it sounds like your day nurse is doing--giving scheduled meds when it's convenient for the nurse instead of when it's actually ordered to be given, then that definitely should be reported.

[jschut, BSN, RN]

Technically: yes, it is. Giving a medication out of the time frame is an error.

Reality: being 3 minutes late with a Baclofen is (IMO) not something worth reporting.

That's the issue. The med in question is scheduled to be given at HS (between 8-9pm). The nurse in question is giving it between 3-4pm.

So when it isn't written in the MAR, I come along and give it at pt scheduled time (8-9). Then when I do my count, I see she has already signed it off as given.

[Meriwhen, ASN, BSN, MSN, RN]

That's the issue. The med in question is scheduled to be given at HS (between 8-9pm). The nurse in question is giving it between 3-4pm.

So when it isn't written in the MAR, I come along and give it at pt scheduled time (8-9). Then when I do my count, I see she has already signed it off as given.

She's giving the dose several hours early, so unless she's got orders from the doctor authorizing it, that's a serious med error. What's worse is that because she's not charting it, you're coming along and giving another dose...and she's causing you to make a med error (albeit unintentionally on your part).

I think you need to have this straightened this out ASAP. And as much as you like your job, I would also consider looking for another job, because if that keeps going on, it's not only her license that could be on the line but yours too.

[jschut, BSN, RN]

She's giving the dose several hours early, so unless she's got orders from the doctor authorizing it, that's a serious med error. What's worse is that because she's not charting it, you're coming along and giving another dose...and she's causing you to make a med error (albeit unintentionally on your part).

I think you need to have this straightened this out ASAP. And as much as you like your job, I would also consider looking for another job, because if that keeps going on, it's not only her license that could be on the line but yours too.

THAT'S what I'm talking about! She does what she wants, with no regard to what is told her.... we just got a new admin, so I'll hang around a bit longer just to see. But if it doesn't change, I will be job hunting within the next few months...

[systoly]

I'd double check all my facts before calling this a big med error, because condition supercedes time. So what if the patient wanted to go to bed at 5pm.