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Discussion

Suspended until further notice

Okay, I decided to sign up on this site because i don't know where to turn to after receiving a call from work today telling me that I am " suspended until further notice"

I was written up for giving ativan 0.5mg via GT q12 PRN to a pt who gets anxiety ( disrobes/grabs when receiving care). That order has been there for months. Family is aware and know that pt has that order. Family want ativan to be given prior to wound tx because pt is so agitated. I had that pt for months and ativan works effectively. I was then moved to a different station for a month and then floated back to the previous station 2 weeks ago for one day. Upon arrival, i checked 24 hrs, counted narcotics, made rounds, gotten report from previous nurse. I asked " does she still get wound tx, with ativan prior?" nurse replied, yes. I was passing my meds in the morning, I came across the tx nurse and asked what time is he going to do the tx. He said " in a few..." So I asked " do you want me to premed the pt?" He said " yes, please".

I checked the Mar.. order was there. Checked the narc drawer, med was there. Checked the last time it was given, it was given the day before. So I gave the med, documented that I gave and was effective after an hr... BUT forgot to sign the PRN box in the Mar.

weeks have passed, I got called in in the office.

They photocopied my documentation, the mar and the " DC order".

Apparently, the ativan was dc'd a week before I gave it. Dc'd a week before the other nurse gave it as well. I couldn't justify that I didn't see the DC on the mar, because i forgot to sign the PRN box.

I recognized the signature of who DC'd the med. It was the QA. The nurse who owned the cart was not aware that the med was dc'd. He made the same mistake, he didn't sign the prn box, but signed the narcotic documentation and narcotic binder. The mar didn't have a DC note when we both gave it. The med was still there. I am just so lost as to how I should feel about this. I feel so ashamed. They cancelled me today, received a call of suspension today until further notice. This is my first job ever, first job as a person, first job as a nurse. I am so scared. I need some advise.

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    • Featured Replies

    • Experts

    Wow that's pretty harsh, especially since there was no harm done. Where I work that would have been an oops. Was the other nurse suspended as well?

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    • Experts

    I agree. A suspension for something of this nature is rather severe unless, of course, there's something being omitted from the story.

    Once somebody receives an order to D/C a medication, (s)he needs to take an extra 30 seconds to highlight on the paper MAR that the medication has now been D/Cd so all oncoming nurses know to no longer administer it.

    Situations like this make me feel fortunate to be working at a facility that has already converted to electronic MARs in which D/Cd medications automatically drop off within a few seconds of being deleted from the computer.

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    • Guides

    I'm really sorry that happened to you. You sound like a very diligent person. If you are otherwise an employee in good standing I would just suggest you be forthright with the facts as you know them. Answer their questions as honestly as you can and keep the conversation centered on your role (vs what some other nurse also may have or may not have done). Tell them you honestly want to know what you should have done differently, emphasizing safe patient care, just as you have here with us. Best wishes to you!

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    This does seem quite harsh for a first time med error when no harm was done to the patient. Just be upfront and honest. sorry this happened to you.

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    I agree with the others that suspension is severe. But as I see it, you made TWO errors. You failed to follow proper facility med procedure by NOT signing the PRN box (error #1). That may or may NOT have prevented you from giving the dc med (error #2).

    Sometimes, it's the failure to follow procedure that is the bigger error in the eyes of the administration.

    Sadly, there is NO way to 100% really know when the dc notation was added on as both you and the other nurse made the same error. I'm curious. Obviously, there is a system breakdown in communication and facility procedure on how to correctly and THOROUGHLY stop an order, which would have included removing the drug from the drawer.

    One question - when was the original dc order supposedly written?? Was this a monthly recap/rollover error that was NOT corrected when July MARs were started for the month. The fact that TWO nurses made the SAME mistake right next to one another suggests a systems breakdown concerning monthly rollovers. So there's ANOTHER error. And the nurse who signed off the order (or didn't) made an error also. And do you guys do 24 hour chart checks ? This may be one big fiasco type error - NOT GOOD. The only saving grace was that the pt was OK.

    Second question - how did the QA nurse catch the error? Was she doing an audit for psychoactive meds or pain mgt or GT care? That's why there's so many systems of checks and balances in facilities to catch snowballing errors like this.

    Just know that these kinds of mistakes usually get tallied up into a cumulative med error report; pharmacy generates a quarterly report also with that info. The DOH can look at your facility's error rate and compare it to a standard average rate and the facility can get in trouble if the rate is too high.

    If you have your own malpractice coverage, you might ask them for some advice. If you've had a shakey time as a newbie, things might or might not work out for you. Same for the other guy. I do hope they consider that the error was prob just not your error alone.

    I've had in-house positions where I had to investigate errors and incidents to compile reports. So that's why I question this occurrence.

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    As reported, that would rate an incident report and a session with a CNE. Mind you it also depeneds on who you are and how much your direct manager loves you. I would get the incident report/CNE. A co-worker who is golden would get a "don't do it again" and it has happened with a drug more risky than Ativan.

    I'd say the family found out and you are an example.

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    • Experts

    I think you should also request that the chart be audited to see how many nurses have given that med after it was discontinued. If this is all to the story...and it seems like it is...it is a little harsh.

    It is a systems error that started with the order not being discontinued properly. Pharmacy continued to fill. NO one noted in the 124 hour check...the list goes on. If you have malpractice...and every nurse should...call them and ask their advice.

    BIG HUGS

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    As 11-7 floor nurse and supervisor, I liked to do monthly recaps. And I would change teams (and floors) sometimes. I liked to do 24 hour chart checks, too. If I took a cart I'd find things, WHY? It would be amazing at the errors I found. I would have to do the investigation, start the med error report, and I would research and include ALL nurses who had erred somewhere along the way. PIA for me but that was my responsibility. I would record all the things I needed to check out on my cheat sheet - the bunch of stuff I had!!

    It made EVERYBODY accountable for their part in an error that shouldn't have happened. I'm NOT out to be harsh but med errors are serious business. And staff would be real PO'd if errors were made on them or their kiddo/family. I've even written myself up for errors, so I know how it feels.

    (You know, I think that would be a good thread if we all described stupid errors we've seen as a means in which to learn from.)

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    I am assuming you work in Long Term Care? Hang in there, it seems at this time they are investigating and their policy is to suspend? . If they write you up for this, have an answer ready on what should have been done. One thing I learned is once a medication is Dc'd it needs to be removed from the med cart immediately. I have worked with a few medication assistants that tend to get in a routine and they don't check the MAR.

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    It may be matter of medications such as ativan are usually not medications that renew automatically month to month. They need new orders and sometimes, depending on the facility, that can be every 3 days, every 7 days. Where QA was involved, this could be the case.

    In any event, sorry this happend to you. If you have a union, see your rep. I would get malpractice insurance if you do not have it, and if you do, ask for their advice.

    Best wishes.

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    So ******...unfortunately, when one nurse does not complete the "job"...everyone there after fails. Computerized MARS are helpful, because there are prompts when boxes are left empty...in some programs, not all. Medical care involves humans and that involves human error :/

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    As a former manager, this is a med error, but not something to suspend a nurse over.

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