Why wouldn't you chart this??

bagladyrn, RN · Apr 21, 2008

I won't hang or administer any med which indicates that it is expired on the label or package. I would obtain a new dose from the pharmacy. If the pharmacist states that the med is safe to give, then he can take it back and relabel it and sign the label to indicate this.

If you administer any med that says "expired" on it, no matter what the reason, you will most certainly be held responsible for any untoward occurance that happens to the patient afterwards, whether or not it was truly related to the med. "The pharmacist said it was okay" is not going to be a valid defense and if confronted with a patient with a major bad outcome, do you really think the pharmacist is going to admit to having told you that? Not likely with his license and malpractice on the line as well!

miko014 · Apr 21, 2008

You must clarify with pharmacy the exact definition of the term expired on.
Does expire on 1/1/08 mean it must be used before 1/2/08 or does it mean must be used prior to 1/1/08.
In the original posters questions pharmacy stated it was OK to use. To me that means it wasn't expired. On the whole question of charting an incident reports is moot.

I don't think that med was expired. I think you need to check with what your pharmacy says, but as long as it's not BEYOND the date on the med, you'd be okay. I'm pretty sure if it was an IV med that it would have month, day, and year (rather than month/year which would be a different argument). But at least where I work, I think that's how it is - good till 23:59 on the date on the bag. If it said 4/21/08, I would use it today. If it said 4/20/08, I wouldn't. There are some meds that are much more time sensitive, like chemo. Those would say "exp: 4/21/08 2130" and if it's going to be hanging beyond that time, we have to call pharmacy. They can come up and extend the date if it's okay for the med, but we can't hang it if they don't.

Again, can't say it enough - NEVER chart that you filed an incident report! You're covering your own toosh that way! Incident reports are for internal review, meaning that the institution uses them to make improvements and look at safety issues, etc. That information is not necessary in a pt's chart. True that you are supposed to chart what you do, but if pharmacy said it was okay to hang the med, hang it. If not, tell them you need a new dose. But don't write in the chart "pt abx dose expired, not given". Like someone said before, that is just ASKING for a lawsuit. Even if you feel like that was the right thing to do, you have to consider the other side of the coin. The pt missed an abx dose. Not good. If that pt later sued, they would ask you why you didn't get them a new dose, etc. Not good! You chart what you did for the pt, not the hoops you had to jump through to do it!

RN1982 · Apr 21, 2008

We had a discussion at the hospital about a nurse that refused to hang meds b/c they were expired (expired that day). When asked how we would handle the situation - I said that I would double check with the pharmacist and if he/she gave me the ok, I would give meds and then document it in the chart. I was told that that should not be documented in the chart? confused...

The only reason I would not have documented that in the chart is because it's hearsay. The pharmacist isn't going to document in the chart that he said it was ok to give expired meds.

txspadequeenRN, BSN, RN · Apr 21, 2008

i don't even know why this is a issue. if the drug is expired don't give it... get another dose from the pharmacy. i would never chart i gave a expired dose of medication that is setting your self up for lawsuit. i would alert my nurse manager and if she agrees with the pharmacist then she can give it and sign the mar....

txspadequeenRN, BSN, RN · Apr 21, 2008

this is the whole deal right here..that pharmacist will be sitting on a beach in tahiti while you are defending your nursing practice in court....it is hearsay and that wont do you any good in court....

the only reason i would not have documented that in the chart is because it's hearsay. the pharmacist isn't going to document in the chart that he said it was ok to give expired meds.

caliotter3 · Apr 21, 2008

I was taught that you never chart anything that will bring attention to your actions or that point out errors as errors. That is asking for it when lawsuit time comes around. You don't chart incident reports. If, for instance, you do discover a mistake, you are supposed to chart objectively what occurred and the actions that happened afterwards without using the words "mistake" or "medication error" etc. In this case, simply don't give a questionable med. If the pharmacist oks the med, then give the med. If you have any doubts, just don't give the med. Don't give it, then chart statements in the chart indicating that the med was expired or that anything else was wrong about the med. That is not very wise. If I were someone looking for info for a lawsuit, I would jump on statements like this being in the chart. You would be handing ammunition to me on a platter. If you ever have questions about charting something, it is always a good idea to check with your supervisor about it before you write in the chart.

Nursebarebari · Apr 21, 2008

That is a big no no to me. I will never administer expired medicine. I always return expired med to the pharm and get new ones.

Freedom42 · Apr 21, 2008

Interesting thread. I'm a student. Could someone please clarify:

Why wouldn't a plaintiff's lawyer see the incident report? Subpoenas usually cover any and all documents related to an individual's case. Why not incident reports?

Are nurses not required to disclose medication errors to their patients? Is the rationale for not requiring these errors to be documented solely to avoid litigation? Is ethical to have a policy that says "incident reports" are for internal review only? Does an ethical nurse disclose the error to the patient?

If someone's willing to tackle these questions, I'd appreciate hearing from you. Thanks.

TexasPediRN · Apr 21, 2008

interesting thread. i'm a student. could someone please clarify:
why wouldn't a plaintiff's lawyer see the incident report? subpoenas usually cover any and all documents related to an individual's case. why not incident reports?
from my understanding (someone correct me if im wrong):
incident reports belong to the hospital. they have nothing to do with the pts record. say i gave a pt the wrong dose of the med. i fill out an incident report. it goes to my nurse manager, and we discuss why it happened. did the med come in 500mg only and i was supposed to break it in half? did pharmacy not put the 'check dose' sticker on the med which creates a red flag to recheck the dose? was the wrong med in the wrong pts box?
incident reports are a time to reflect on how and why something went wrong.
assuming the pt wasnt harmed, and the md was notified (which you would put in the incident report) nothing goes in the pts chart about you botching up their medications.
a laywer will never find this document as it belongs to the hospitals risk management team.
are nurses not required to disclose medication errors to their patients?
if i gave you 500mg of a med, and u were ordered at 400, but the 500 was within acceptable ranges of a med, and the md was aware, i dont think i would mention it. or, i'd say, we gave you some extra with your last dose to help hold you over. (some md's will give you a verbal order for the one time 500mg dose - kind of a cya)
is the rationale for not requiring these errors to be documented solely to avoid litigation?
certain situations need to be documented. if you gave a pt a whopping dose of meds and they coded..well, enough said. maybe someone else could help me out with this question though..
is ethical to have a policy that says "incident reports" are for internal review only?
sure. its for making things better, and seeing what went wrong. if they can avoid the error again, then its a good cause.
thats my on the subject..someone else might have some different ideas and opinions..

CiCigirl · Apr 21, 2008

Poopsie-
If a med expired that day, I'd still give it.
As for the question of why you shouldnt document that in the chart, its for legal reasons.
Say you documented ' meds expired but per pharmacist ok to give '
Then later on pt becomes septic and dies.
Family decides to sue (as they always do) for who knows what reason.
Now the lawyers get to see the chart. They see the line you have charted above. Ah HAH! They have all of the ammunition that they need.You gave an expired med. Pt didnt get the right concentration of meds b/c you hung an expired med. Now hes dead. Lawsuit won! Your license on the line.
As other posters said, you'd do an incident report. You would never ever document in the chart that you filled out an incident report, because they the lawyers could track it down and find our exactly what happened.
Does that help explain things a little more clearly?

:yeahthat:

Freedom42 · Apr 21, 2008

Thanks for your reply, MeghanRN.

anurseuk · Apr 22, 2008

Yeah, for me I'm reading it as the drug has expires on the 23rd (for example) written on it and today is the 23rd so will expire as soon as it's 00.01 on the 24th... so you can give it.

If it was a drug I was not familiar with I would double check with pharmasist or nurse in charge but wouldn't need to document anything as it hadn't actually expired yet.

I would let the shift coordinator know as a mater of curtosy so more could be ordered.