This doesn't seem right to me....what are your thoughts?

[LatinGirl]

I work nights at a psychiatric facility. The facility has had a rough year with the constant changes in administration as well as several citations from the state. Last week I was doing chart checks and came across an order for a client to have Concerta 27mg qAM. The client was already on Concerta 27mg qNoon, but the doc did not a D/C order for the original order of Concerta. I saw the nurse took it off the way the doc wrote it, chart checked it and continued on with the rest of my night. The next night I saw the day nurse gave the Concerta qAM, but D/C'd the qNoon dose, but there was no order to do so. In the AM I asked the nurse about the order and told her I did not see an order to D/C at which point she replied well I just assumed. I told her we as nurses can't make assumptions and if the order was confusing in any way she should have called the doc to clarify....which she eventually did just to find out the doc never wanted the original order D/C'd...the client was supposed to have 2 doses each day. Fast forward a week and the nurse who originally took the order off and transcribed it to the MAR is fired and the nurse who D/C'd it without a doc order is not. The reasoning according to my DON is that it was an error in transcription that led to the med error...the client missed 2 doses before the order was corrected. Does this may sense to you? The nurse transcribed it as written....how is he to blame for what the other nurse did or did not do?

[P_RN, ADN, RN]

If there wasn't any indication in the progress notes then a call to the ordering doctor should be made. I can imagine 2 at least reasons....the patient wanted it in the morning instead of noon, OR the doctor wanted to double the dose at split times. Who knows, only the doc.

[Mulan]

What was the "transcription error"? It sounds like it was transcribed correctly.

[LatinGirl]

It was transcribed correctly, that is what I don't understand. The DON said she would have made the same assumption as the day nurse and the the evening nurse should have called and verify the order to make sure it was correct. The thing is the doc always writes orders this way....to split doses twice a day instead of one larger dose once a day.

[NPinWCH]

I agree, but I honestly don't think anyone should be fired for this. This just causes nurses to cover things up and not report errors, which of course causes more errors. The key is fix the problem, not place blame. So unless there is a repetitive problem for one of these nurses, such as multiple write ups/warnings, then some counseling and education should have taken place first before someone was fired.

I mean, next time someone makes a mistake are they going to want to fess up to it if they think they might get fired?

[steelydanfan]

I work nights at a psychiatric facility. The facility has had a rough year with the constant changes in administration as well as several citations from the state. Last week I was doing chart checks and came across an order for a client to have Concerta 27mg qAM. The client was already on Concerta 27mg qNoon, but the doc did not a D/C order for the original order of Concerta. I saw the nurse took it off the way the doc wrote it, chart checked it and continued on with the rest of my night. The next night I saw the day nurse gave the Concerta qAM, but D/C'd the qNoon dose, but there was no order to do so. In the AM I asked the nurse about the order and told her I did not see an order to D/C at which point she replied well I just assumed. I told her we as nurses can't make assumptions and if the order was confusing in any way she should have called the doc to clarify....which she eventually did just to find out the doc never wanted the original order D/C'd...the client was supposed to have 2 doses each day. Fast forward a week and the nurse who originally took the order off and transcribed it to the MAR is fired and the nurse who D/C'd it without a doc order is not. The reasoning according to my DON is that it was an error in transcription that led to the med error...the client missed 2 doses before the order was corrected. Does this may sense to you? The nurse transcribed it as written....how is he to blame for what the other nurse did or did not do?

would not even go there if I were you....