State Survey, med error and more!

[the_alchemist]

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 :imbar:sniff:

[eldragon]

10 mg is a common dose for Lexapro and 50 mg isn't.

These documentation errors are easily made in the nursing home setting because so many people are overworked and in a hurry. First mistake was made when the order was put on the MAR, either a computer error (typo) or written error. Then documentation errors continued for who knows how long before anyone noticed - and too bad it took a random chart audit before anyone noticed it!

Trust me, this is why I just quit my nursing home job, after almost two years there. Day after day of too much to do and not enough people to do it - forget it. I was about to burn out. Every time I worked the med cart, I found errors and fixed them. Every time I did treatments, I found errors and fixed them. Each and every nurse has to look at the orders and make sure they are all written correctly and match the drug they are giving.

Too many nurses stand there and punch the cards without even LOOKING at the MAR! That's how the simple little documentation error ends up snowballing into something huge.

Bottom line is that the facility will be sited for it. Yes, you can lose your license or have it suspended also. Not that it will happen, but it has happened. Not too long ago, a nurse here had her licenses suspended for 3 years because state saw she was late with her med pass every morning, consistently ignoring the times and starting her med pass at the opposite end, where she should have been ending at. She was giving the 0800's at 1000, and the 0900's at 0700. State inspectors saw that she had such little attention to detail, and that she could hurt someone with her carelessness. They suspended her license for 3 years.

Not to spook anyone, but we must all remember that, although it seems like nursing home positions aren't important and there are so many errors that there is no way to fix them all - so many people do not even try - it's your license you are putting on the line every time you initial that wrong entry on a medical document.

And that's just one reason why I finally quit and took my intact license, energy and sanity elsewhere.

[the_alchemist]

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.

this actually got me relieved, since we never run out of the drug. i spoke to my supervisor and gave him the name of the person who called and he said that he indeed was in the facility at the moment. i hope it was all legit, coz had i given the info to somebody else, then i'll have one more thing to worry about, no hippa violations please..

[Schmoo1022]

Hi..We have been through this at our nursing home too. The surveyers wanted to know why after two checks of the MAR and the pharmancy check , NO ONE caught the error. The facility was sited, but no particular nurse. However, the staff was very quick to to point out whose error it was.

[the_alchemist]

10 mg is a common dose for Lexapro and 50 mg isn't.

These documentation errors are easily made in the nursing home setting because so many people are overworked and in a hurry. First mistake was made when the order was put on the MAR, either a computer error (typo) or written error. Then documentation errors continued for who knows how long before anyone noticed - and too bad it took a random chart audit before anyone noticed it!

Trust me, this is why I just quit my nursing home job, after almost two years there. Day after day of too much to do and not enough people to do it - forget it. I was about to burn out. Every time I worked the med cart, I found errors and fixed them. Every time I did treatments, I found errors and fixed them. Each and every nurse has to look at the orders and make sure they are all written correctly and match the drug they are giving.

Too many nurses stand there and punch the cards without even LOOKING at the MAR! That's how the simple little documentation error ends up snowballing into something huge.

Bottom line is that the facility will be sited for it. Yes, you can lose your license or have it suspended also. Not that it will happen, but it has happened. Not too long ago, a nurse here had her licenses suspended for 3 years because state saw she was late with her med pass every morning, consistently ignoring the times and starting her med pass at the opposite end, where she should have been ending at. She was giving the 0800's at 1000, and the 0900's at 0700. State inspectors saw that she had such little attention to detail, and that she could hurt someone with her carelessness. They suspended her license for 3 years.

Not to spook anyone, but we must all remember that, although it seems like nursing home positions aren't important and there are so many errors that there is no way to fix them all - so many people do not even try - it's your license you are putting on the line every time you initial that wrong entry on a medical document.

And that's just one reason why I finally quit and took my intact license, energy and sanity elsewhere.

when i finished my BSN i told myself i wont apply for a position in a SNF/LTC/nursing home and sort. but i received my license at a very bad timing, when hospital jobs are on freeze and if any, they need at least 1 yr experience.... so i told myself, i needed to start somewhere and will take the first decent job offer. and so i did.

anyway, the stress level is so high in our facility. in as much as i'd like to give my 110% to every patient, i can only do so much to pass meds to at least 30 patients, some of which really demanding, receive calls from the pharmacy and call MDs when needed, plus families interrupting and everything else in between. trust me, i could barely sit down for a break and it makes me skip lunch which i never get paid for! most pts i had was 38 in 1 day, and sure it was killing me literally! if only i had a choice, i'd quit.. but i don't have any choice right now.

so anyway, i was able to speak with the staff who had written down the 10mg order. the original order was 10mg which appeared as 50mg to whoever wrote it in the MAR initially and hasnt been caught during the recap! and yes, my fault too, i relied on the med label and the fact that Lexapro is commonly given in 5, 10 and 20mg for the dosage... *sigh, wonder what's in store for me on my first day back at work..

[NurseLoveJoy88, ASN, RN]

State is coming soon to my job you make me want to triple check our mars.

[the_alchemist]

State is coming soon to my job you make me want to triple check our mars.

u better do... i tried to do all the "clean-up" for everything i could see before i went on leave, and still there's a lot more they could find from way back (they found the error in the September MAR).

[eldragon]

State is coming soon to my job you make me want to triple check our mars.

Do it anyway.

Do it for your license and your patients. Always read the MAR and make sure the medication matches the written order. If it doesn't, stop what you are doing and go check the doctors orders.

Again, I put in my two years at a SNF. I just finished my notice yesterday and now I'm not even going to think about updating my resume for two months. I need to REST!

[mlk1217]

Very common in LTC. No harm to the pt so I think you'll be ok. I agree, you have no idea who is on the phone, cant discuss facility business. Its not possable to do the job correctly with the given patient loads. Once I thought I gave my pt's meds twice, soma, narco, ambien, and something else. Shortly after I walked up to the pt's door and herd her say to the aid, "my legs are tingleing" I almost FELL OUT!!. Went back to the MAR and rechecked only to find that I han not made an error, researched a bit and found this to be typical for this pt. BUT we have ALL made errors. Next meeting the DON will gripe a bit, but thats usally all.

[the_alchemist]

I got back to work after my leave. I had to see for myself what went wrong here. I have a couple of things I need to point out.

1. The medication was ordered last week of August. It was NEVER carried out. No 24 hr check was done. When I querried on this one, the Supervisor said that "the NOC charge nurse who worked that night is no longer is us." Apparently, that nurse has been terminated for another reason.

2. We get new MARs starting on the 11th of each month. Recaps are done before then, at least 2-3 days before. I have never done recaps myself, but I know that they double/triple check the new physicians orders and countercheck with the old MAR. did they catch it? NO.

3. Unfortunately, I came on the 2nd day since the new MAR has been out. There was a first signature before mine. It was initialed. I'm not sure if it was a "mistake" that I was too honest to acknowledge that "I might have accidentally initialled the MAR, but I keep notes to prove that there was no supply for this medication at that time, and so does the Pharmacy." The first person who initialed went on saying that he "clarified with the doctor." my question is when? why hasn't it been changed so it was already updated the next day?

4. I was written up for this, and I did acknowledge because the note written there was "signed the MAR even if the medication was unavailable." And it is just ME (and I was told the other nurse too) that was written up for this.

5. This was caught during the survey, and apparently the patient's Na level became abnormal. Does it have something to do with the medication "being given?"When did this happen?

There are a few other things which I will write as I go no, but for now, I would like to hear comments from you. Thanks a lot!