State Survey, med error and more!

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hi all! i need some information to shed light on my concern right now. I had been on leave from work for 3 weeks now, and still have a week to go before i'm going back to work (and this is not a vacation, just important matters i need to sort urgently).

So while things are turning out better on my side and getting ready again for work, i received a call from DPH asking me about a certain drug. This drug comes in 10 or 20 mg, and on the MAR it says 50mg. It has already been clarified with the MD that it was supposed to be 10mg, but for some reason the MAR hasnt been updated. I remember giving 10mg all along, however i was questioned why it has been signed as 50mg. I asked the other nurses how they have been giving the drug, and same as i did, they gave 10mg.

So i told the surveyor (on the phone) everything that i could remember about the drug. i was concerned that there might be other questions he might have, so i told him that if there's anything else that needs to be clarified, i can make my way there and discuss the matter with him. I talked to my supervisor and he said he doesn't know yet whether or not it's gonna get me in trouble. At this point, i dont feel like going back.. im really scared... (my only consolation is that this patient is still in the facility, still alive and in good condition, havent had any side-effects documented, and likes me a lot as his nurse).. but still, i worked hard for my license and never did i intend to harm someone :cry: :imbar:sniff:

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Specializes in Legal, Ortho, Rehab.

Oh lord!!! I would never talk to a surveyor without said document in front of me, or some kind of reference. If I understand your post correctly, you were signing for 50mg, but giving 10mg b/c it was clarified, but never fixed???? This is very bad. Or hopefully, the order was changed, and the error happened while you weren't there...in that case I still believe you shouldn't have spoken to the surveyor. Many new nurses don't know how to handle the inspectors, and get diarrhea of the mouth and getting themselves in trouble. Remember, this guy gets paid to find error. He is not on your side. Let this be a listen to treat them as if you had "Miranda rights". Let your DON be your "lawyer".

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Your facility is going to get dinged for Nursing because of this, and rightly so. If you knew the dose was supposed to be 10 mg., why didn't you change the MAR? Why didn't any of the other nurses change the MAR when they saw the disparity?

At this point, there is no reasonable defense for these actions. The survey team will read it as a persistent medication error, and the findings will be written to reflect that. The level of the offense is probably still to be determined, but that there was a persistent error is, by virtue of the signed MAR, indisputable. It's not likely that you will be singled out for disciplinary action as the blame seems to be spread out amongst every nurse who gave the questionable dose.

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Is this what your "time off" was about? Was there some random MAR audit that caught an ongoing error, or was there an event that happened and someone retrospectively examined the MAR and this was thought to be the source of the problem? What was the med?

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i went on leave for a family emergency...

I know i shouldn't have answered the call as my husband told me, but i was expecting other important calls and thought it was one of them!!!!

The drug is Lexapro. the supervisor randomly audited the MAR some time is Sept and changed the order to 10mg, re-written, and re-ordered with no problem. I recently started working day shift so i had no idea how it was being given before then, but at some point i remember that it has been 10mg all along because instead of coming in a card, it was in its original foil container and put in a zip-lock bag.

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exactly why I hate working in a nursing home setting. The state surveyors are so nitpicky about the most retarded things ever. I remember when I worked in a nrsg home how everything has to be just so "for state." Didn't make a lotta sense to me then, and still doesn't now.

yet one more reason for me to love my job in a hospital acute care setting. None of the bs that nrsg homes have to go thru. After state, hospital inspections are a JOKE:)

ps:to OP...Please don't worry about your license over this incident. If anything, there will be a report including all nurses involved, but for God's sake if they wanna take my license for accidently signing a 50 mg Lexapro order off, then i say "take em." I have better things to stress about:)

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Oh lord!!! I would never talk to a surveyor without said document in front of me, or some kind of reference. If I understand your post correctly, you were signing for 50mg, but giving 10mg b/c it was clarified, but never fixed???? This is very bad. Or hopefully, the order was changed, and the error happened while you weren't there...in that case I still believe you shouldn't have spoken to the surveyor. Many new nurses don't know how to handle the inspectors, and get diarrhea of the mouth and getting themselves in trouble. Remember, this guy gets paid to find error. He is not on your side. Let this be a listen to treat them as if you had "Miranda rights". Let your DON be your "lawyer".

my husband told me the same thing. i was actually in the middle of something when he called, but because i was expecting other important phone calls so i answered it hurriedly and i was caught so unaware of it! i told him i'd call him back, which i did after i spoke to my supervisor. my heart is till pounding!

as for the MAR not being updated, it was rewritten by another staff member and i was told about it, so that's what we had been signing ever since.

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We're human, we all make errors and we need to learn form them. I would think the fact that no one was hurt or died from is error is important to all involved. If this is your first med error you'll always remeber it, I do.

WAlk back in to work confident in your skills. Every nurse has made errors. You stepped up and told the truth and admit you are open to feedback.

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just got me thinking.... could they actually do that? do they have the right to call and question an employee on leave and ask questions about something? because when he called, he introduced himself and said that he would like to clarify about a this medication for this patient, and i said that i am on leave and in the middle of something at the moment (and i said it in a very nice way), and still asked me if i can remember how the 50mg dose has been given. like was it five 10mg pills? or however it may have been given. i said i couldnt answer at the moment and that i'll have to check with the facility, then i'll call him back. then he said that he was just wondering because it was originally 50mg then it was changed to 50 and all that, as if he wanted to to answer instantly. we spoke for 2mins 41 sec. just got me to think if they actually could do that.... (i'm supposed to be on leave, right?)

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you really dont even know who you were talking to. Further more, it's a HIPPA violation to discuss that pt info if you don't know who is on the other end of the phone. SImply forward his calls to your hospital's legal rep. Repeat that you are happy to meet with him at his workplace at a scheduled time (with your hospitals lawyer). It sounds to me like someone (not the hospital) is looking for fault in the system to establish a lawsuit $$$$$$$! The hospital wil totally back you. CAll your supervisor or director of nursing. DPH, is that department of heath? How did this man get your phone number?

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Specializes in LTC, Memory loss, PDN.

Lexapro in tablet form is available in 5, 10, and 20 mg respectively. If your supply was 10 mg tablets, said supply would have run out way too soon if 50 mg were administered. So if there was no supply problem it would stand to reason that it was administered as intended/ordered. There is still the matter of the MAR being incorrect and signed as such, but as you stated, the patient received what was ordered and subsequently no harm was done. How much of a deal the surveyors are going to make of this may in part depend on whether they were targeting MARs specifically or just found this by chance. Unfortunately, med errors are a big problem with LTCs leading the pack. AS far as the call is concerned, surveyors are required (at least in my state) to show identification and are required to allow employees to contact admin about their presence.

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you really dont even know who you were talking to. Further more, it's a HIPPA violation to discuss that pt info if you don't know who is on the other end of the phone. SImply forward his calls to your hospital's legal rep. Repeat that you are happy to meet with him at his workplace at a scheduled time (with your hospitals lawyer). It sounds to me like someone (not the hospital) is looking for fault in the system to establish a lawsuit $$$$$$$! The hospital wil totally back you. CAll your supervisor or director of nursing. DPH, is that department of heath? How did this man get your phone number?

i work as a rehab facility and yes, DPH = Dept of Public Health i thought i was lucky that state came while i was on leave (and i was on leave for an important family matter). when i called him back i told him that if need be, i can find time to go down there and clarify the matter, with documents before us. i just called the facility trying to get hold of the DON, but i was told the surveyors were still there and that she'll call me back. i just hope she (or somebody else) will, because i don't need one more thing to worry about while in the middle of a family crisis, sad to say.

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