Why wouldn't you chart this??

[Poopsie Gigglebuns]

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...

[pagandeva2000, LPN]

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...

From what I am reading, and can gather from your statement, I would not hang it at all if they were expired that same day. If it were expired at a particular time that day, like say 5 minutes before, I'd call the pharmacy and ask (that would take more than 5 minutes, anyhow). If it becomes expired, say within a few minutes or the next day, I would call the pharmacy, not administer until they send up new meds, inform the RN and tell the doctor what the delay is. And, I would not administer under any circumstances.

I would never document that an incident report was written. Not only does it raise a red flag, it also can be considered to me as negative charting if I mentioned that medications were expired.

[miko014]

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.

no. an incident report is not a legal document and not part of a pts chart, that is why it is not with the pt's medical record. if, however, you chart that one was filed, you give the lawyer the information s/he needs to get his/her hands on it. you do chart whatever med you gave - wrong med/dose/time or whatever. you have to, because the pt got the med. you don't chart it like "med error made pt received wrong med!!!!!". you just chart it like any other med (scan it in computer, mark it on the mar, however you do it at your institution). just what you gave, how much, when, and that the doc was notified - and whatever action was taken, if any. example - "aspirin 325 mg given at 0900. dr. whoever notified, no new orders at this time" or something similar. "coumadin 20 mg po given at 1900. dr. whoever notified. stat pt/inr ordered, vitamin k 5 mg po given." whaever. only chart what happened with the pt, and chart it objectively!

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)

you're supposed to tell the pt you made an error. if you gave the wrong dose, just tell them that "i didn't give you enough of your med a little while ago, here's the rest of the dose" if it's possible to make it up. if you gave too much, just tell them that they had a bit too much. if it was the wrong med, you need to tell them and make sure they don't have an allergy or anyhting. of course the physician must be notified, and you have to tell the pt what to look out for if it was something that could cause increased ses, etc. remember, the pt will not win a lawsuit because you gave them an extra aspirin. they have to be able to prove that whatever you did caused them lasting harm, and giving an extra dose of a med would most likely not do that.

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..

you still have to document them even if nothing bad happened. if, say, they were on bedrest, but you let them ambulate in the hall, you just chart that the pt ambulated in the hallway. you don't add "even though they were supposed to be on bedrest" unless, of course, you told them not to walk and they did it anyway. again, you are not charing "alert! alert! an error was made!" you are just charting what happened.

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.

yes. this is the way it has to be. an indicent report goes above and beyond what you would chart. it looks at the hows and the whys as well as what happened. if it wasn't like that, errors would not get reported and they could easily be repeated. an error is very rarely the fault of one person. it is most often a system error, and reporting it allows them to make connections between situations and pushes for process changes.

thats my on the subject..someone else might have some different ideas and opinions..

same goes for me! anyone else, feel free to comment!

[PsychNurseWannaBe, BSN, RN]

Med errors happen… you should contact the MD, informed the patient and notify your nursing supervisor.

Then you fill out an incident report and put it in your manager’s mailbox.

You then chart…MD notified that patient received Percocet at 1900. Patient made aware. No new orders. No adverse effects noted.

Remember incident reports can be used for many things. Meds, patient injury, equipment failure, elopement, falls, etc…. Regardless of what the incident report is used for…it never gets charted!

[cherrybreeze, ADN, RN]

This is an old post, but since I came across it, I'm going to comment anyway (who knows, it still may help someone).

Whatever the expiration date is on a med, it's the END of that day. So if the date on my med was 11/6/08, I could give it until midnight. We usually only have an issue with that on PCA bags; they have to be changed by midnight on the date it's considered expired.

But no, you wouldn't document that...no reason to. If it's the day after the date listed, you don't give it.

[Freedom42]

Student here. I did some reading about this after reading this thread the first time around. What I learned:

Incident reports are not always confidential. In some states and under certain conditions, it can be used against hospital personnel in a lawsuit.

This has nothing to do with "certain incidents" being subject to confidential documentation in a hospital system. The incident report itself is considered an administrative document. If you make reference to it in your chart, it is subject to subpoena and can be used against you in court.

[Christen, ANP]

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...

Unless the med says "expired 11/5/08 at 1600" and I'm due to give it on 11/5/08 at 1400, it's expired. I'd discard it and order a new dose. I wouldn't bother checking with the pharmacist because I'm not going to give an expired med so I wouldn't worry about documenting it. :)

In general, however, I'm of the "document everything" group. If it's not documented, it's not done. If I have a situation which is potentially dangerous and I take the time to consult with pharmacy or the MD, I document it.

[uscstu4lfe]

i don't think hanging a med that has expired THAT day is detrimental. i mean, it's not a ticking time bomb where as 11:59PM it's OK to do it, but at 12AM it can cause harm. you have to use a little common sense and not make a mountain out of a grain of sand