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To mind own business or...

Nurses   (1,184 Views | 11 Replies)
by VeronicaMarie VeronicaMarie (New) New Nurse

187 Profile Views; 2 Posts

kind of a rant sesh so sorry. but where I work we get blister packs of meds.. we even flag the mar with a blue insert that says RESIDENT IS CURRENTLY ON A SHORT TERM MED to prevent omissions. well when you notice the blister pack hasn't been popped and resident didn't receive morning dose of med do you report it or do you move it along and mind your own business because either way it will come to surface.  I know this is a touchy subject cuz the girls at my work are all overly sensitive and hate to own up to mistakes...but its annoying. there was a note  about the resident needing to start the med on the 15 and then an email sent out because we do email report offs to the team incase people miss the nurse notes. again, all to prevent stuff like this. we cant make it any easier. so WHY was the morning dose missed on the 15th when this resident desperately needed the antibiotic started.??anyways... rant over lol... do u report omissions u find ?

Edited by VeronicaMarie

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SilverBells is a BSN and specializes in Rehab/Nurse Manager.

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Is it possible the first dose was obtained in another manner? Back up pharmacy, E-kit, etc. That could possibly explain why one isn’t missing from the bubble pack. 

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Jedrnurse has 25 years experience as a BSN, RN and specializes in school nurse.

1,480 Posts; 14,063 Profile Views

It's all well and good to ask anonymous people on AN what their opinion is, but what is the policy of your employer? Usually a missed med requires reporting, period. If there is an investigation and it turns out that there wasn't a mistake, fine, but the investigation should turn up why the confusion happened in the first place.

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ruby_jane has 10 years experience as a BSN, RN and specializes in ICU/community health/school nursing.

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5 hours ago, Jedrnurse said:

It's all well and good to ask anonymous people on AN what their opinion is, but what is the policy of your employer? Usually a missed med requires reporting, period. If there is an investigation and it turns out that there wasn't a mistake, fine, but the investigation should turn up why the confusion happened in the first place.

^that.^ Always check the policy.

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CharleeFoxtrot has 7 years experience as a ADN, RN.

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That's a medication error that should be reported or at least questioned.  If for no other reason that someone else questioning you-or anyone else medicating that patient afterwards about why there is one more pill in the pack. Besides, most bosses think it's an important thing for patients to get the medications as ordered.

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Glycerine82 has 4 years experience as a ASN, LPN and specializes in SNF/Rehab/Geri.

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Our first dose always comes from our generic pyxis and when the card comes it can look as if they didn't get their first dose when in actuality they did. 

I dont' report other nurses for things like that unless its blatant.  I may say something to the nurse themselves though, in a way where I am looking out for them, etc. 

If how they reply makes me suspicious I may start paying closer attention or something but I always give the benefit of the doubt and try to mind my own. 

I think the worst thing we can do to each other is report genuine mistakes provided no harm has come to the patient. 

Perhaps it would be looked down upon, but I'd rather cover for my fellow nurses if  I"m sure they learned from it because in my facility med errors are punitive and I personally think thats a bunch of crap. 

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Been there,done that has 33 years experience as a ASN, RN.

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11 hours ago, Glycerine82 said:

Our first dose always comes from our generic pyxis and when the card comes it can look as if they didn't get their first dose when in actuality they did. 

I dont' report other nurses for things like that unless its blatant.  I may say something to the nurse themselves though, in a way where I am looking out for them, etc. 

If how they reply makes me suspicious I may start paying closer attention or something but I always give the benefit of the doubt and try to mind my own. 

I think the worst thing we can do to each other is report genuine mistakes provided no harm has come to the patient. 

Perhaps it would be looked down upon, but I'd rather cover for my fellow nurses if  I"m sure they learned from it because in my facility med errors are punitive and I personally think thats a bunch of crap. 

So, you feel it is more important to look out for fellow nurses that make mistakes... rather than look out for the patients?

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TriciaJ has 39 years experience as a RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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6 hours ago, Been there,done that said:

So, you feel it is more important to look out for fellow nurses that make mistakes... rather than look out for the patients?

I agree with this.  Incident reports serve a variety of functions and it's a bummer when they are used punitively.  They can elucidate systems errors so they can be fixed.  If there was ever a major event that caused an investigation, then a discovered pattern of "little" errors can hurt everyone's credibility.  "Covering" for another nurse can bring liability on the "coverer".

This would actually be a very good question for the OP to bring up with his/her professional liability carrier.  Also would be a good idea to discuss the "punitive" aspect with management if possible; they could head off a lot of potential problems if they didn't punish staff for being human and being accountable.  But this may be a long shot; if they're "punitive" in the first place, they are unlikely to be receptive to any discussion of this.

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Glycerine82 has 4 years experience as a ASN, LPN and specializes in SNF/Rehab/Geri.

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On 12/20/2019 at 12:02 PM, Been there,done that said:

So, you feel it is more important to look out for fellow nurses that make mistakes... rather than look out for the patients?

Absolutely not, which is why I said only when no harm has come to the patient.  Transcription errors or minor things like senna-s instead of senna, etc. especially in cases where  the error is identified way after the fact. 

 

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Glycerine82 has 4 years experience as a ASN, LPN and specializes in SNF/Rehab/Geri.

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On 12/20/2019 at 6:27 PM, TriciaJ said:

I agree with this.  Incident reports serve a variety of functions and it's a bummer when they are used punitively.  They can elucidate systems errors so they can be fixed.  If there was ever a major event that caused an investigation, then a discovered pattern of "little" errors can hurt everyone's credibility.  "Covering" for another nurse can bring liability on the "coverer".

This would actually be a very good question for the OP to bring up with his/her professional liability carrier.  Also would be a good idea to discuss the "punitive" aspect with management if possible; they could head off a lot of potential problems if they didn't punish staff for being human and being accountable.  But this may be a long shot; if they're "punitive" in the first place, they are unlikely to be receptive to any discussion of this.

perhaps I should have said "turn a blind eye"  I just dont' think turning someone in is always the best thing to do.  

I also don't think its right that I have to medicate 20 patients and document based on what type of insurance the patient has, but I digress. 

The system is so horribly broken.  

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Just me. specializes in None.

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A mistake is a mistake, but how it is handled should be according to facility policy.  A purpose for reporting things like omissions, to keep them from happening again.  It is not a personal attack.

Was the medication signed off in EMR? or paper chart?

It has been a long time since I worked in ltc, but is there an in house pharmacy?  We used to have a room with stat meds, some antibiotics.  We used it when waiting for the deliveries.  

Could the nurse have been called to double check if dose was given, if not it be given asap?  On your shift?

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scribblz has 3 years experience.

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8 hours ago, Just me. said:

A mistake is a mistake, but how it is handled should be according to facility policy.  A purpose for reporting things like omissions, to keep them from happening again.  It is not a personal attack.

Was the medication signed off in EMR? or paper chart?

It has been a long time since I worked in ltc, but is there an in house pharmacy?  We used to have a room with stat meds, some antibiotics.  We used it when waiting for the deliveries.  

Could the nurse have been called to double check if dose was given, if not it be given asap?  On your shift?

I worked in LTCs/SNFs for years as an LPN and had many similar experiences of questioning if my patients were getting their meds accurately. 

My first step was always to look through the med cart for the small blister pack from the e-kit if found I stapled it to the dispensed card from the pharmacy to prevent further speculation on "where the doses given came from".

2nd step if I can't do that,  communicate with the nurse in question. If they can clearly explain where the med given came from, ie. Mr Smith who passed away last week had a card of Prednisone or zpak same dose, and it's just been sitting on the destroy pile in the med room. I would tell them I understand the logic in using it, but it's against policy and makes it look like the med wasn't given. I wouldn't turn them in on the first offense officially. If I have a good relationship with my manager I might tell them to let them know unofficially. If I think the punishment will outweigh the crime; I would keep it to myself as long as there is reasonable evidence the med was given.

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