do you think I should be written up?

Altra, BSN, RN · Feb 15, 2012

In a month of caring for the patient ... wouldn't you have seen some change in the MAR (a 10 or 14 day course of antibiotics, for example) ... or other evidence of the patient's plan of care being altered/accommodated to include the treatment of an acute infection? I'm assuming the patient's symptoms had to have progressed ... so I'm just questioning how this could have gone completely unnoticed by all the nurses caring for the patient, not just you.

psu_213, BSN, RN · Feb 15, 2012

I want an opinion if you will....I am an LPN in a nursing home working the evening shift. A nurse on the day shift took an order from a dr. to start a resident on an antibiotic a month prior. She passed onto to me in report the order was taken and the med was ordered from the pharmacy. I have a med tech that passes meds on my shift so never saw the EMAR. I charted in the progress notes that resident continued on antibotic therapy and was afebrile. A month later I find out after the resident has a uti that has festered for a month, that the day nurse never entered the order in the computer or ordered the med from the pharmacy, but, because I charted that entry, I am written up for "falisifying information" because I charted something that wasnt true. I am told it was my fault for not checking on the other nurses order. What do you think? I dont think I am at fault. do you?

You will probably not like my answer, but you are partially at fault. Yes, the day shift nurse has some responsibility in this--she flat out said that she took the order, charted the med, ordered the med, etc. There has to be some type of double check and you cannot chart "on antibiotic therapy" unless you know for sure that they are (plus, in my mind, just charting "on antibiotic therapy" is a waste of time/space--let the fact the antibiotics are charted on the MAR be enough proof that they are on ABX therapy--sorry, just a little double charting pet peeve, and it caused trouble in this case). You really have no business charting this unless you either pass the med yourself or, at the very least, see that the med is signed off in the MAR.

Now I know that sounded harsh, but you need to move on. It happened. Accept your role in it and make sure you know how to prevent if from happening again.

netglow, ASN, RN · Feb 15, 2012

How would you never see the EMR?

NicuGal, MSN, RN · Feb 15, 2012

I have to agree, you should be checking the EMR for meds your patient is on and making sure they did receive them. That is part of your responsibility. And yes, you charted something that was not true.

Esme12, ASN, BSN, RN · Feb 15, 2012

Well...I agree with psu 213. You are the licensed person "in charge" of the "unlicensed" med tech, therefore, you are the one to be responsible for their inadequacy. This is the problem with in utilizing non-licensed personnel to perform under the licensed personnel. Yes, the RN bears the responsibility for not writing the order.......but you documented the patient received a med that was not only not given, it was never ordered.

So......you falsely documented an intervention that never occured. Assuming will not cover you by any standard. Is that fair? Well, NO....but it is the harsh reality of utilizing the cost saving measures by using unlicensed personel. When the order was new, as the next licensed person to be "in charge" of the patients meds, you should have ensured that and the med was transcribed to the EMAR correctly and that the order was carried out correctly from that point. If you are charting it, you better be sure you are correct.

The reality that you will still be held accountable for the non licensed person is a tough pill to swallow......but there it is. Stinks doesn't it? Just as the RN is responsible for you in the tasks you perform, as being the "most responsible" legally. Tis is one of the HUGE reasons everyone should carry malpractice insurance.

catlvr · Feb 15, 2012

Daisymae, I agree with the other posters: yes, you bear responsibility as well, and yes, it stinks. I hope that the responsibility for the error was shared by all of the staff (esp the person who said that they took the order off!), and hope that the pt is okay.

I've learned to be (quietly) paranoid about all that I do in nursing - if someone said that they did something for a pt is who now my responsibility, I'll check to make sure that it was done, especially if it is important or is something that I will follow up on, like a med given and its effect. I don't like to be this way, but I'm kind of anal about making sure that my pts get what they need and that my bottom is covered. I work in subacute/ltc, so I well know how little time we have to do what should be done, but that's how it goes.

When I give report, I ask the nurse who is picking up from me if I have missed anything, and to please let me know - that way I can do better. I do the same with the nurse who I am picking up from. I would not turn someone in (unless it was a totally horrible error), but I would let someone else know if there was something amiss, and hope that they would do the same for me. I think that over-communicating like this has helped the care that I give, since things are less likely to slip thru the cracks in the madness of ltc.

KelRN215, BSN, RN · Feb 15, 2012

I agree with everyone else. Yes, you are partially at fault. How do you go about charting that the patient is on antibiotics if you never actually LOOKED to confirm that they are?

I don't work with med techs but I'm assuming their job is to give the ordered medications. They do not have a license and, ultimately, you are responsible for what you delegate to them. That said, I don't see how the fault could lie with the med tech at all in this situation as their job is to give the ordered medications and they cannot give what is not ordered. "I never looked at the EMAR because I have a med tech giving my meds" would not hold up as an argument any more than "I never looked at my patient's VS to notice that their temp was 105 and their BP 80/30 because I have an aide to my VS for me". You're the one with the license, so the responsibility ultimately lies with you. Though, I also wonder how in a month, no one noticed that this patient was, in fact, not receiving antibiotics.

The previous nurse may also be somewhat at fault but, based on what you posted, we have no idea if she actually didn't order the medication from the pharmacy or if this somehow got lost in the shuffle. She reported it off to you that the patient needed to start this antibiotic, shouldn't you have followed up on that?

GGT1 · Feb 15, 2012

Is this antibiotic only given 1 time per day (on your shift)? How could this go on for a whole month is what I am confused about. But regardless, I agree with the others...you are the licensed professional and responsible for overseeing those unlicensed professionals working under you.

RN/Mom · Feb 15, 2012

Yes, you are definitely at fault if you documented something that wasn't done. Getting something in report isn't enough! I often get information in report that I later find is completely false when I actually 1) check the pt or 2) check the order.

Last week, for example, I received in report from a fellow LVN that one of my patients had received his evening dose of IV antibiotics and was currently receiving IV fluids. As soon as I did my rounds/assessment, however, I found that my pt wasn't receiving any fluids and when I looked at the time written on the empty antibiotic bag hanging on the IV pole, it was from day shift. As soon as I discovered this (thankfully before evening shift left), I notified the RN from that shift (who was covering the LVN who gave me report) and she took care of it. Had I not done proper rounds/assessment and just "assumed" the pt was on IVF and documented such, I would have absolutely been at fault, too.

Bottom line is, it doesn't matter that the original mistake occurred on the previous shift or that you were given false information in report. Once you assume care of that patient, you are accountable for checking orders and making sure they get carried out (especially when they're delegated to non-licensed staff). Tasks/information/orders can easily get overlooked when they go through lots of different people (pharmacy, RN, LVN, Med Techs). In the end, it is the licensed staff (especially RNs) who have to sort it all out and verify it's getting done correctly.

Wave Watcher · Feb 15, 2012

You should always check your EMAR. Do not assume anything. You are at fault.

nurseprnRN, BSN, RN · Feb 15, 2012

yep. don't ever assume that someone did something unless you see it in writing. your charting was a lazy act (and i agree with the no-double-charting rule, btw) and probably an automatic one, judging by the snf charting i review. next time don't be so automatic-- actually check for what you're taking responsibility for. sorry. hope you have malpractice insurance if this comes to legal action.