Suspicion About Med Error

[Sharmilagrg00, ADN, RN]

Hello everyone,

I have a suspicion about one new nurse who has  started working by herself in past 2 weeks. I understand being new nurse and working by yourself, you are prone to make mistakes and with time you will learn. But if it’s regarding patient safety, I don’t know if I should express concern or should I keep quiet. 

We have one patient who has dementia with behavioral disturbance and he has been prescribed trazadone and citalopram. Before she was working on floor, the resident was calm and would sleep through the whole night and would get much needed rest. But since she has started working, I have noticed after her shift in evening, the patient is agitated and wouldn’t sleep all night, would be yelling all night long. The thing is I have been advocating for this residence for a very long time since I found out that CNA are not changing him because they don’t want to wake him up as he starts to yell when he wakes up. So I am afraid that this new nurse might not be waking him up to give medicine if he is sleeping which is scheduled around 8. I really don’t know what to do since I don't have proof but just suspicion but I am worried about my patient because missing antidepressants/sedative medication might harm patient. Or is it okay to miss 2-3 dose of these medicine? Please fellow nurses , help my patient . Thank you.

[JKL33]

This situation first and foremost begins with a full assessment of the patient. Numerous medical conditions could cause such a change; there are the classic things like some sort of infection and many more; even just a natural manifestation of his disease might cause waxing and waning of his behaviors.

It isn't appropriate to assume anything about the care this newer nurse is providing. However, assessing all possibilities could be appropriate if carried out in an appropriate manner and done without making assumptions. Perhaps you could simply ask her how the patient does at taking these 8 pm medications that have seemed to help him. Let her know you are looking into the changes you've noticed and wondered if he had been giving her any trouble with taking those medications.

Be very careful here. If you want to help your patient it's rarely wise to jump to conclusions.

[Sharmilagrg00, ADN, RN]

Hi JKL33,

There has been no problem in taking medicine for this patient. He never refuse any medicine that’s y So far we were able to manage his symptoms successfully. We have been documenting his behavior which has been normal when other staff are working evening shift. But I will look into it and will talk with her if there has been any other problem . I just want best for my patient . I am just worried that hopefully they are not missing medication because he is sleeping because I have seen that he was not given proper and timely incontinence care because they don’t want to wake him up Causing many skin issues but I have handled that. I just want to make sure that  he is not deprived of care he needs because it will be too much work if he wakes up. 
 

thank you so much JKL33.

[JKL33]

2 minutes ago, Sharmilagrg00 said:

There has been no problem in taking medicine for this patient.

I suggested you ask her about this because it is an easy and collegial way to bring up the topic; to inquire about whether she is having any problems giving him his medication.

It is not appropriate to state "I am concerned you may not be giving him his medications because you don't want to awaken him when they are due."

Quote

thank you so much JKL33.

You are welcome. I'm glad you want to advocate for him.

[Crystal-Wings, LVN]

Write them up.

[chare]

1 hour ago, Crystal-Wings said:

Write them up.

Who you think should be written up? 

And why do you think this would be an appropriate response?

[Crystal-Wings, LVN]

1 hour ago, chare said:

Who you think should be written up? 

And why do you think this would be an appropriate response?

Well gee, I GUESS op should consider writing up the nurse she was talking about that keeps “forgetting” to give a certain patient their medication. Why do I think it would be an appropriate response? Because the nurse she is talking about is making a med error. 

[Sharmilagrg00, ADN, RN]

Hi guys , thank you all so much for your input but I am just suspicious about it, I am not sure and I don’t have any proof. I just cannot make assumption . I just wanted to know what would be an appropriate action here. Like JKL33 said, I did ask the new nurse about it and she said there has been no problem in giving medicine and may be it was just an off nights for my patients. And she only work 1 eve this week, patient was still same for three nights I worked. Hopefully there has been no error and we could work some how to help my patient together. Thank you again.

[Jedrnurse, BSN, RN]

15 hours ago, Crystal-Wings said:

Well gee, I GUESS op should consider writing up the nurse she was talking about that keeps “forgetting” to give a certain patient their medication. Why do I think it would be an appropriate response? Because the nurse she is talking about is making a med error. 

The way I read the OP, they're not sure if this is happening, they're simply wondering. A "write up" would be inappropriate.

Like your sarcasm.

[myoglobin, ASN, BSN, MSN]

There are numerous reasons for new onset patient agitation including delirium, discontinuation of other medicines, changes in family visits or changes in underlying physical condition.  To make an allegation against a coworker based only on a suspicion would not be warranted in my opinion. It might be worthwhile to suggest that the nurse in question call the patient's MD to request a new order. Perhaps, trying a different medicine such as mirtazapine might be more effective.  

[SpaceCowgirl, BSN]

There's plenty of reasons why a dementia patient would have agitation, it seems very strange to me why the first assumption was that the nurse was withholding meds ... Unless you have some other information about her that would make you suspicious, I think this is really unfair.

[BeenThere2012, ASN, RN]

On 10/29/2020 at 10:57 PM, Crystal-Wings said:

Well gee, I GUESS op should consider writing up the nurse she was talking about that keeps “forgetting” to give a certain patient their medication. Why do I think it would be an appropriate response? Because the nurse she is talking about is making a med error. 

Because it is not known for certain she is not giving the medication, it is just OP’s concern that she “may not” be giving it.  Writing up a colleague is not a minor thing and should only be done when you are certain wrong-doing is going on.   Short of that, would be having a conversation with a supervisor or manager before making a formal complaint.

As JKL mentioned, there also could be other causes for the patient’s change in behavior that should be assessed before jumping to conclusions and potentially missing some other sort of treatment the patient may need.