Singled out because I gave too many narcotic analgesics??(long)

[JessicRN]

This is long and complicated but needs to be told. I have spent the most horrible 7 days of my carreer. Last week I got a call from my nurse manager who told me that during a routine narcotic medication audit. My name came up and It was found there were discrepancies in the narcotic count in the pixis. (This is a new system they inputted. At the end of the month each unit would recieve a printout of the person who took out the most narcotics on their unit. They were then audited to see if the medication can be accounted for if they can't a report will have to go to the DPH).

Well my name came up for the april audit and during that audit 2 drugs at 2 different times were not accounted for. There was to be an investigative meeting with the nurse manager the director of nursing my union rep and myself, but in order for them to find a date that suits everyone, it was to be the following week. I spent an entire sleepless anxiety driven week. On wednesday this week I came to the meeting and saw that sure enough I withdrew 2 narcotics from the pixis on patients who had been discharged and there was no MD order for the medication not to mention the fact that one of the patient was an express pt that I do not go near. Unfortunately the person who can access the pharmacy records was not there and the machine to access the medical records was down so nothing could be discovered. All I knew my ID was used to access the narcotics and the patients they were accesed from I never would have given those medications to not to mention they were already discharged or admitted. The entire group worked with the info we had which was a list of all my narcotics pulled for the month and who I gave them to and a list of all the patients for the day, and tried to figure out who I could have given the meds to what could have happened. It was decided that it was a pixis error. I somehow keyed in the wrong name but although my nurse manager believed it was an accident, I still had to account for the missing narcotics or the DPH would be notified. I left the meeting with no answers but some possibilities. The one thing I was told that the charting she already saw of mine was meticulous and she felt it would be easy to find the missing medication because of it and in the event she could not,that it would hold well in the event that the narcotics could not be accounted for and the DPH being reported.

The next meeting was not scheduled until the 20th of June. I left the meeting completely shellshocked I had to come back to work that night and every night for the next three nights with that hanging over my head. I could hardly function I was so stressed. I did tell my coworkers because they saw something was obviously wrong everyone was shocked. (They were shocked that it was me including my boss because if there is one word to describe me and medication giving, it is anal. I refuse to give anything that is not written down I follow all the rules of giving meds I document the second I give the meds. I do vital signs before and after every analgesic and document pain assessment rarely do patient leave with pain and if they do it is documented). The thought that I did this and could not prove that it was not intentional when we already have had three nurses dealing with separate narcotic medication issues (two of the nurses no longer work here because of it).

Today I spoke with my nurse manager she took the time to check all the possibilities and told me she was able to account for the narcotics because everything she needed was in my documention. Apparently on both occassions, there were patients with the same or nearly the same name the same. I had chosen the wrong names each time. (Since the people I chose should have been taken out of the pixis when they were discharged. I never thought to check unit numbers as there was no name alert on them.) I was completely vindicated and there will be a new system implemented for the pixis as a result. I won't even have a mark in my file as this can not be called a med error since the right pt recieved the right drug and the ordered was written by the MD and documented on the right chart by me, it is only a procedural error. :monkeydance: :monkeydance:

I have never felt so relieved but now all I feel is paranoia and anger. I still can't believe I was audited because I give too many narcotics??? I work in an ED and I am a staunch advocate for people in pain. Although everything I gave is ordered each time by an MD and my documentation can support the need for the medication. But now I am afraid to give more then one dose of medication to a pt and I am afraid to give too many narcotics even when they are ordered for fear my name comes up again. Also when I go to the pixis now and I am totally paranoid I will make the same mistake . I won't go without the written order and the pt chart. I check the name the ID and medical record number on the pixis before taking the med. I won't leave until I am sure I signed out (Just 4 weeks ago in this unit a nurse forgot to sign out and someone stole some narcotics in the 30 seconds it took for the machine to sign itself out). Then and only then will I leave the room to give the med. Will I ever make the same mistake NEVER but I was audited because I am a conciencious nurse and care about a persons pain, that makes no sense. If I had not have given so many narcotics my name would not have been red flagged. (audits are usually only done by the pharmacy board or yearly and they are random) this is totally a new system that was instituted recently and has singled out two innocent people (the other nurse was placed on administative leave which is what would have happened to me if the med was not found, until her case was resolved but she quit from the stress). The scary thing is the night staff will always be flagged because there are only three of us on at one time and we have no assignments we share the entire load as a team. I could be giving meds to 20 patients at a time at least and having to remember to document on each not just the med but the pain assessment. My coworkers are also now ancious because they could be next and worried their documentation might not hold up to the scrutiny. This is not a random check like they do with chart audits. How many times am I going to get flagged? I know I should just relax and be secure that I chart well and won't make this kkind of mistake again but this is a busy ED and charts get misplaced all the time before people can finish charting. Also every nursing book says you should prepare your medication in a quiet area with no interuptions try that in an ED.

The only thing that saved me was my charting and it is funny all my coworkers used to make fun that I charted so dilligently in the ED or that I refuse to give a med that is not written down. They are not laughing anymore.

This is a lesson for all nurses ONLY YOUR DOCUMENTATION WILL SAVE YOU

had my documentation not been so good and my history of being so anal,my boss might not have taken the time to search for the answer and discovered what happened so fast. I am still reeling about how close I came to risking my carreer over a stupid stupid error. Maybe now I can get some sleep.

[mrscurtwkids4]

What an awful experience to have to go through. I can't imagine how stressful that was for you. On the bright side, you didn't do anything inappropriate, you document well, you have set a good reputation for yourself; all of which helped to prevent blame being placed without investigating as thoroughly as possible to find out where the discrepancy was at for those meds. Even though I'm a graduate student who hasn't officially started work, I know that even during clinicals I was paranoid about giving medications for fear that I would goof something up. Some healthy fear of messing up is what will help prevent me from making mistakes. The instructors always drilled into us the importance of documentation. They would say "DOCUMENT, DOCUMENT, DOCUMENT" and "If it wasn't documented, it wasn't done." These are definitely things that have been drilled into me since the start of nursing school. Doubt I'll ever forget it, especially when I hear these lessons learned by other nurses. Thanks for sharing and glad things worked out!

[happybunny1970]

Obviously this organization has had a problem with at least one nurse in the past diverting medications, but I think this is taking it WAY too far. To put you through all that for TWO DOSES OF MEDICATION over an entire month's time is ridiculous. Given that you have clearly worked there for some time now, to find two 'errors' should have directed them to talk to you without involving an entire group of people. Not to mention, to be asking questions like that 6 weeks after the fact... how in heck are you supposed to remember anything? Especially in Emergency?

Their 'idea' is a bit misguided as well... to single out nurses who withdraw the 'most' narcs in a month... well, obviously that's going to be people in ICU or ER or Post-Op consistently, and at the same time you could have a PRN or Part-Time or Agency nurse come in and withdraw a significant amount for their own use over a day or a few days and it would never match that which was given by one of these full-time staff over a month's period of time. They need to find another way.

Kudos to you for your documentation! This is EXACTLY what you needed to prove your innocence, and it is a shame that this experience has made you hesitant to practice. Unfortunately, this is what often happens: if there is an accusation of any sort, the nurse ends up guilty until proven innocent. And thank you for sharing this story -- I'm sure all who read it will be a little more careful themselves.

[RosesrReder, BSN, MSN, RN]

I am so sorry this happened but thankful that you posted. As soon to be nurse, I really appreciate the advice and will be just as anal as you with my precise documentation!

[rn/writer, RN]

I'm so glad you were vindicated. You can be grateful and proud of yourself that you are such a meticulous charter.

A couple of things to keep in mind as you process this event:

#1 You WERE vindicated. That is the bottom line here. You were tested and found up to the challenge.

#2 This is NOT personal. It's important that you not view this as being about you, because from everything you described, it isn't. You can make it about you if you let it overshadow your thinking and turn you overly paranoid. Then your attention will be compromised. I say "overly paranoid" because good nurses are always a little obsessive, and it's to everyone's benefit. The bad thing is when that healthy obsession becomes crippling obsession.

#3 Instead of viewing this incident as a bad thing, look at the good that came out of it. You were found to be in the right. You manager recognizes and has acknowledged that your level of charting covered what happened. Other nurses have seen the benefit of your careful ways. And, as a result of this event, pharmacy will be making changes to protect you and your co-workers from similar problems. Those of us who read your account have the opportunity to remind ourselves to be extra careful and to document to the hilt. It might not feel like a victory, but you won all the way around.

You could look at this last week as getting beaten up and feel bad, or you could look at it as if you won a difficult wrestling match on behalf of yourself, your unit, and, most of all, your patients. They need nurses like you, and you passed the test. Congratulations.

Be proud of how you practiced. That's what protected you.

[teeituptom, BSN, RN]

there are some shifts in the ER where I feel like Im no different from a pusher., do they still call them that

[CarVsTree]

I'm so sorry for your difficult experience. There system for auditing is extremely flawed. So now, if one wants to divert narcatocs, they just need to make sure they're stingy with the narcotics for their patients.

If they want to audit (which is a good idea I'm sure). It should be completely random.

Sounds like adding a LOT of unwarranted stress.

[TazziRN, RN]

Jess, you were not singled out, if the policy is to audit regularly and look closer at the nurse who gave the most narcs in a time frame. It was just your turn. The meds were accounted for, you were never accused of anything. In fact, your manager tried to help you find the discrepanc. If anything you were completely supported! I understand your stress level, believe me, and and I'm not minimizing it, but if I were in your shoes I'd be going to the boss and thanking her for her support.

[MrsMommaRN]

It is obvious that you are a great nurse. I can't imagine what those days were like for you, knowing how meticulos you are about documentation. Its sad that a few bad seeds make the system harder for all of us. I am glad things worked out well for you in the end.

[clac2009]

Ya'll are all right on document, document, document. I start my clinicals in the fall, so I'm not a nurse yet, but for the last 13 years, I have been a paralegal working on personal injury cases (plaintiff and defendant sides). The saying is true "if it's not documented, it didn't happen". I can't tell you how many cases we had where the nurse didn't document, but she swore up and down she did something for a patient. Sometimes I believed them and sometimes not - either way, it really didn't matter b/c the written record is all you have to go by. Look at it this way, in Texas (at least), a person or family members have 2 years to file a personal injury lawsuit or wrongful death lawsuit - so, you could go 2 years before being called to testify if the wrong was done in a medical setting - you won't be able to remember and the only thing you will have to go by is your nursing notes. So, good job Jess on your documentation!

[walk6miles]

First of all, you sound like my kind of nurse..... I spent two of the most miserable years of my life in severe, breath-sucking PAIN... only two surgeries finally relieved my pain - at several times during the painful time, I begged God to let me die; the pain was that severe.

As a result of my experience, NO patient of mine will ever have to ask twice or even ask the first time if they are experiencing pain. The relief of my patient's pain is MY JOB!!!

Thank God for your meticulous charting and for PYXIS. You are allowed to make mistakes; you are a great nurse and you have a clear conscience.

Great post- a lesson to us all - God Bless!

[oramar]

Don't get me wrong, I like Pixis, but I have seen glitches that tripped people up and caused a lot of grief. That old saying "to err is human but it takes a computer to really screw things up" is very appropriate with Pixis. Good for you for keeping up with your documentation. Thumbs up to your manager who assumed you were innocent.