What did I do wrong?

[mzsuccess]

OK. So I'm a Cna while in nursing school. I work at a retirement center. And I was assigned to sit with this gentlement who had a stroke. One evening while sitting with him he gets really agitated and starts yelling, screaming at his wife. Kept getting up saying things were out the window that wasn't there, asking was he going to doe and couldn't sit still. I thought he was honestly going to hit his wife..I never seen him so upset. Now I'm not suppose to give meds we give them to his wife and she gives them to him. Every other day, the mangers are changing the "what to do" forums and who to call and his son also. He's on hospice. I called the triage nurse because it was late. I explained to her what was going on and I told her he had ativan and she told me to give it to him. ThT was two days ago and now. I get to work and I hear I'm in big trouble and the son is so upset yelling. Saying it was the wrong medicine, but it had his name on it and he's now messed up. Anyway I'm suppose to have a meeting tomorrow and don't know what to expect. I feel bad and everyone is looking at me crazy like its my fault and I don't know what to tell my boss. I feel embarrassed and it makes me not want to be a nurse anymore. Plus the wife is fabricating the story and she isn't all the way in her right mind. How can I handle this or should've handle this? I charted everything, like I was suppose to and other girls gave it to him and didn't chart anything.

[thevez]

This is not correct. In most assisted living facilities, it is part of a CNA's practice to ASSIST in giving meds (assist being a really broad term). They open prepour med cases, take from blister packs, and otherwise assist in what is supposed to be a pretty independent resident to take their medication. Any number of residents are not really suited for assisted living, and should be at a higher level of care, however, they are kept for the money they pay long after they should be. However, the key is a prepour or locked medication box that is done up by a nurse, that a CNA helps pull from. Doesn't mean it is right or necessarily safe, however, it is done every day.

In this instance, the OP is a CNA at home for a hospice patient. When a hospice patient is at home, again, family (or if able, the patient) has the prepoured/lock box medication they need. Again, and all of this depends on POLICY of the individual agency--they can and do "assist" in administration of medications.

What I believe is the issue is that there was an acute change, and the licensed nurse triaged this change over the phone. And directed to a lock box that was outdated, and unclear on which med was to be given by the cognitively impaired wife--the CNA did the best that was available. Again, I say it was on the licensed nurse who delegated to a CNA to assist in giving a med that was discontinued, still in a lock box.....it would have been no different if the wife called, and the triage nurse directed HER to give a med that should not have been there, used the incorrect name of the med, whatever.

There are also many, many CNA's who take a course on medication administration and are able to give residents meds in long term care. These are stable residents who live at a facility that assists in many ways. Much like there's CNA's who take a course on physical therapy and become restorative aides, focusing on physical function. Does that increase the risk of falls?

Assisted living, long term care, and palliative care at home are very different than an acute care setting.

And thevez, if in fact an error occurs and the documentation is such that the RN/LPN delegated incorrect medication administration to the CNA, it is on the licensed person. The CNA is tasked to give meds that the nurse is responsible for making sure is correct.

Thank you for the long explanation. Where I work,nurses give the medications straight to the patient. Not CNAs. There is just too much risk for medication administration.

[Nibbles1]

On my phone anyway, I hit the "reply" button then when that box opens I hit the "reply" button a second time and then the quote/post I am responding to appears.

Figured it out kind of by trial and error. Hope that helps :)

Thank you for sharing!! I thought I was the only one couldn't quote/reply. I hate technology. Yes, I said hate!

[Nibbles1]

I have never ever heard of a CNA giving meds. Especially pre-pouring meds is a big no no.

[Nibbles1]

Aww thanks Gooselady that meant so much to me. I got really worked because these are fragile people and the last thing I want to do is harm them in any way. Hospice or not.

We all take the oath: Do No Harm. Even doctors take an oath to Do no harm. Good luck! So glad everything worked out in your favor. And I bet you know Haldol and Ativan when you study pharm.

[hookyarnandblanket]

This discussion brings up a related question I've often wondered: if, as CNAs, we see a nurse administering a medication incorrectly and we know that either the patient doesn't take it or they have confused it with another drug, do we speak up and say something? I work with a RN whom I could see making such a med error. She lacks quite a bit of common sense (she once got the entire nursing staff in trouble by microwaving a dry blanket) and I would hate to see a patient die or be harmed because someone made a med error and I knew it when it happened.

[ktwlpn, LPN]

I have never ever heard of a CNA giving meds. Especially pre-pouring meds is a big no no.

OMG!!!!Please READ the thread before you respond.This CNA did NOT "give meds".Holy smokes...

[ktwlpn, LPN]

This discussion brings up a related question I've often wondered: if, as CNAs, we see a nurse administering a medication incorrectly and we know that either the patient doesn't take it or they have confused it with another drug, do we speak up and say something? I work with a RN whom I could see making such a med error. She lacks quite a bit of common sense (she once got the entire nursing staff in trouble by microwaving a dry blanket) and I would hate to see a patient die or be harmed because someone made a med error and I knew it when it happened.

As a cna you may not know HOW to "correctly" admin a medication or if a new med was ordered or something was discontinued.You can stop the nurse from giving them to the wrong resident,that's not an uncommon mistake in LTC.Listen while she is speaking to the resident ,if she uses the wrong name you can say something-she will be grateful you saved her butt.You can help prevent med errors in LTC by not interrupting the nurse while she is pouring meds.

[Nibbles1]

OMG!!!!Please READ the thread before you respond.This CNA did NOT "give meds".Holy smokes...

Excuse me? I was one of the first responders on this. There was another person saying CNA's give meds. Go back at the very beginning and re-read before you make ANY comment to me.

[ktwlpn, LPN]

Then you need to use the quote function correctly to avoid misunderstandings like that,sorry.

[blondy2061h, MSN, RN]

This discussion brings up a related question I've often wondered: if, as CNAs, we see a nurse administering a medication incorrectly and we know that either the patient doesn't take it or they have confused it with another drug, do we speak up and say something? I work with a RN whom I could see making such a med error. She lacks quite a bit of common sense (she once got the entire nursing staff in trouble by microwaving a dry blanket) and I would hate to see a patient die or be harmed because someone made a med error and I knew it when it happened.

I hate to sound like a jerk, but please don't think you know more about the patient's situation and their prescribed meds than the nurse.

[kbrn2002, ADN, RN]

This discussion brings up a related question I've often wondered: if, as CNAs, we see a nurse administering a medication incorrectly and we know that either the patient doesn't take it or they have confused it with another drug, do we speak up and say something? I work with a RN whom I could see making such a med error. She lacks quite a bit of common sense (she once got the entire nursing staff in trouble by microwaving a dry blanket) and I would hate to see a patient die or be harmed because someone made a med error and I knew it when it happened.

You better be 100% sure a mistake is about to happen or you will not make your nurse happy! If you find a med not taken at bedside, of course let your nurse know it wasn't taken. That may not be an error though so just be straightforward about telling the nurse and don't act judgmental. I have many alert and oriented residents with orders to self administer their meds after I leave them and I will not take kindly to a CNA assuming I am not doing my job correctly. As far as confusing a med with another drug, how on earth would you even know? You are not the one checking the MAR, checking the drug or administering the med. If you are even able to notice that one pill out of many looks different, unless you are the one giving the meds you need to pay attention to your own job and not your nurses. On the other hand if you see me about to give meds to the wrong resident please alert me, I will be very grateful.

[hookyarnandblanket]

I hate to sound like a jerk, but please don't think you know more about the patient's situation and their prescribed meds than the nurse.

Perhaps I should have tempered my question with more information. The LTC where I have worked and my now current employment at a hospital are small, rural locations. The atmospheres are very laid back; nurses share information about medications, their general use, and what we need to look for in administration to a patient freely; all the CNAs coming on shift, unless they are in surgeries, sit in on the report from the off-going RNs, so we hear about patients first hand, meds, condition, all. There are times we probably function more like a PCA than a CNA because of our staffing numbers. We get asked to assist with catheter insertions (not the actual act, but by keeping the patient in position), IV insertions (again, positioning), telemetry set up, and sometimes we have to assist in the ER.

Our function at my hospital is obviously an outlier, and not the norm. There are times when there isn't an extra RN around to help and we are asked to step in and help. When that happens, I listen and pay attention to what is happening and ask questions later in an effort to expand my knowledge base. The nurses at my hospital put quite a bit of trust in the CNAs, and I would say the providers do, too. I had a provider ask to relay a request for an one-time dose of an IV medication, medication name and dosage, to the nurse assigned to a patient because he couldn't leave the patient in the middle of his assessment. I never touched the med; I only passed on the request. Things are probably much more casual where I work than most.