What to do, who to call

My situation is this: I am an LPN working in a SNF through an agency. I have seen such gross mismanagement of patients and callous attitudes about it that it shocks me. I have written letters to the DON of the facility but she appears to not care. My agency is strictly staffing and has no nurse manager to advise. These are some of the things that bother me: 1. An MD wrote an order for Coumadin with PT/INR on the chart of a post CVA pt. The supervisor who noted the order booked the labwork but didn't order the Coumadin or put it on the med kardex. It was discovered the next week when the PT/INR was done. I overheard 2 supervisors laughing about it "what difference does it make, she already had a CVA". BTW, minimal residual dysfunction from the original CVA. 2. An MD was faxed re: a patient with sudden lady partsl bleeding. First the supervisor hid the return fax and the RN who sent it looked for it for 3 days. The fax order was to obtain pelvic U/S. That was 3 weeks ago. when the orginal RN (who works 11-7 and couldn't schedule it himself) asked about it, the supervisor's response was along the lines of "why bother, what are they going to do about it anyways". 3. The dtr of a pt with metastic CA who is in denial (the dtr not the pt) requested that pain meds be d/c'd because they might be making her mother confused. Instead of either the nurse or MD educating the dtr about need for meds, they were d/c'd. Now the pt screams and cries all night in pain. 4. Abnormal test results are not phoned to the MD but are faxed even after office hours. A noteable example was a pt with a crtitcal potassium of 1.9. Rationale : pt is DNR. 5. Meds are given at inappropriate times. Examples regular and rapid-acting insulins (Novolin, Novolog) are given up to 2 hrs before meals. Once a day AC meds are scheduled for 6:30 AM, breakfast is at 8. Since the med pass is heavy and scheduled at the end of shift, these meds are given starting at 4:30 AM. I was taught that AC means 30 mins before the meal, not 1 1/2 to 3 1/2 hrs. The response to this concern is that night shift needs to "do their share".

I could continue to go on, but you get the idea. Any suggestions? I know that I personally can just move on to the next contract, but this really bothers me.

Catherine