Hello fellow nurses. I have something to get off my chest, and I cannot discuss this with coworkers so I sought out all of your opinions. FYI: I am a new grad RN, currently working in LTC for about 7 months.
A few months ago, during a med pass at 5 pm (supper), I left a pill in the pill cup next to a resident who normally will take the pill, if not, the aide will help her take it (it was senokot). When I left it there, I acknowledged to the resident that I am leaving a pill beside her and would like her to take it. A family member of another resident sitting at the same table, saw this and commented "She won't remember to take that," in a very rude manner. In response to her hostile personality, I was firm and told her "She usually does take the pill, if she does not, I will follow up and be back to make sure she does". I left saying this and administered pills to the other residents at this time. I came back to the same table while giving a pill to another resident sitting on the same table as this family member and the original person I left the pill beside, I asked the aide "did A.I. take the pill?". The aide responded and said yes. I then proceeded to administer the crushed pills to another resident while waiting for her to finish IN FRONT OF this family member.
This family member then went to my director and reported me for inappropriate medication administration. I was written up for something that did not even result in harm or distress for a resident. I was disciplined for "leaving a medication beside a resident that has dementia," instead of waiting 5 minutes to help her take it, I proceeded to admin meds to the other 30 residents before time runs out.
I honestly feel like this is unfair. Also, my director was very strict and had a look of no mercy when telling me that this is just "unacceptable practice". Also, the family member who reported me has a history of issues with many co-workers, and the management team knows that.
So, tell me, give me your honest feedback. Would you write me up for this? I feel a sense of indignation towards my director.
I have worked a LOT of LTC over the years. I would circle a med as refused LOOONG before I would leave it lying around. More like I would NEVEr even if the pt was AAO x 3.
Specializes in Adult and Pediatric Vascular Access, Paramedic.
Here we go again...
1) Like others have said it is not within the scope of practice of the nurse's aide to administer medication or to make sure the resident takes it, it is your responsibility.
2) You are dealing with a patient with dementia and she may not take the medication, she may throw it on the floor, in the trash, down the toilet.. you have no idea where it ends up even if she says she takes it.
3) If you are documenting the resident took the medication, but you didn't see it, you are falsifying documentation.
4) I am assuming if you have one dementia patient in the ward there are others, maybe even the patient's roommate who may inadvertently take the medication meant for her roommate. It doesn't matter whether you feel the medication is harmless, it would still be a med error and could still harm another patient.
5) MOST IMPORTNAT YOUR PATIENTS, I AM ASSUMING HAVE GRANDCHILDREN THAT MAY COME VIST. YOUNG KIDS WON'T HESITATE TO TAKE WHATEVER PILL IS ON THE TABLE IN THE CUP, BECAUSE IT LOOKS LIKE CANDY, AND EAT IT. THE MEDICATION SAFETY YOU FOLLOW AT HOME IF YOU ARE EXPECTING THE POSSIBILITY THAT THEIR WILL BE CHILDREN PRESENT ARE THE SAME ONES THAT YOU NEED TO FOLLOW AT WORK!!!!
Yes, I would write you up. If I was the family member of a patient and witnessed this, yes I would report you, as I would wonder if my own family member is getting the correct medications or if she is just taking the ones you leave on the table in the room for her roommate!
Please read the Nurse Practice Act for your state so you are more aware! I would be more worried that they will report you to the BON!!
I think it depends on the policy at your work place. I know that in school nursing settings (not nursing schools), they let unlicensed but trained people ensure that the students take the medication according to the medication card. If your workplace allows aides to ensure patients take medication, you're ok. If not, you're not ok. The keyword here is 'assist', unlicensed people should not be allowed to administer the medication to the patients but observe and supervise the patients taking the meds themselves and ensuring the completion of it as well as the 5 rights.
Basically what everyone else has said. Never leave a med unattended. Who knows, another resident could walk over and take it. If you didn't witness it administered, then it wasn't administered. When I'd work in LTC, I'd come back at the end of my pass, if they still wouldn't then I'd chart they refused.
Unfortunately we all do this...I think a good nursing administrator should acknowledge that while giving a verbal warning. Yes, it's technically wrong and there is a potential for serious harm, however the argument can be made that you remained in the dining area and so you continued to "supervise". Also, regarding the CNA, I'm sure it varies from state to state, but in Pennsylvania, the CNA can assist a resident by saying "that is your bowel pill the nurse gave you" (a verbal prompt). They can also assist the resident to grasp and lift a pill cup or pill on a spoon to their mouth (with the resident's consent). The nurse poured the pill and stated to both the resident and the CNA that it was medication to be taken at that time.
Again though, it is incorrect and warrants a corrective action...but one with perspective.
Yes in most places you would have to be written up. It is against LTC regs to leave medications out. A facility could be fined and cited if this family member reported it to them. It would be cited as an IJ (immediate jeopardy) by state surveyors and would require a lot of paperwork for the facility to prove they fixed it. Also a surveyor might find other things during the survey, so no facility wants to risk all this trouble. It is considered "immediate jeopardy" because the potential for harm of having someone else take the medication. Many other types od cites in long term care will be relegated to a less category if they in fact did not result in harm. Medication issues are taken more seriously, and are cited harsher in regards to potential for harm. In your case, if another demented resident took the medications, harm may not have been done being that it was Senakot, but you would have learned the lesson from a lot of scowling CNA's lol.
Survey enforcement and quality measures are heavily reported online and drives consumer choices about where to put their loved one, so no facility also wants this to decrease their subacute (higher paying) referrals or jeopardize their relationships with referral sources. This will affect their bottom line and therefore, yours as well
You will find in healthcare an increase of heavy regulation that drives the behavior of managers in LTC and HH settings. It is not that personal against you. Nursing is a long curve of developing that judgment and understanding. A profession based on use of judgment will naturally have a higher amount of criticism when you use your judgment - it is part of shaping your judgment and improving it.
If you look up regs such as OBRA, Medicare PPS, Medicare conditions of participation on cms.gov and your state regs for LTC (usually Dept of Health), nursing home compare, etc; you will understand the larger context of the issue. It may help you align your behavior to meet the expectations better. It will also maybe run like hell from management lol.
Was the write-up an oral warning, just documented for the state, or a written warning? A trouble-making family member left your manager no choice. I would have done an oral warning, mostly to let you know not to do it in front of anyone. It is NOT a good practice, but I have worked in LTC and I am aware that short cuts are taken. Try not to do it, Okay?
I wouldn't have written you up just explained to you why you shouldn't leave meds unattended. I know the pill was only Senna but what if you had a narcotic in the cup and it was unattended next to the resident and another resident walks in the room and takes it (and ends up being allergic to said narcotic). I know that is drastic but it can happen. I always make sure my patients take all of their medications right in front of me. If they ask if they can leave it next to them and wait I tell them I'll take the pills and come back. I don't care if its only iron and a stool softener. My workplace really stresses not leaving pills unattended. Honestly just learn for next time, that's all you can do. It doesn't make you a bad nurse. Good luck!
The thing is, it's not correct policy. It's just something you NEVER do. Like, leaving the baby by the pool for just a second.. You just don't do that. Also, I assumed you charted that the med was taken but you don't really know. That's another problem. Third, what if a patient who already has loose stools would have taken it and fell while rushing to the bathroom? It could have caused a sentinel event. So it seems silly, you were busy, real world vs policy...I don't know if I wod have written you up but as there was a complaint it might have been rather unavoidable. Perhaps if we spoke and you realized the issue/possible consequences, I might have let it go with a strong verbal. Not being an administrator, I don't know, but maybe the administrator was obligated to write you up. Just take it as a lesson learned and move on. I guess you could have attempted to give the pill later or just not given it, charting refused. Do that next time.
I had a res once who would not under any circumstances take her meds for me and several other nurses. The only way we could get her to take her meds was to let her favorite cna give them to her. I was there in the room trying to get her to take her medicine and she would spit them out at me. The cna asked to try and the res opened her mouth like a little bird and swallowed ever pill. From that moment on I would take the cna with me to give her her meds. I know its not right but sometimes you just have to pray you dont get caught.
I think that's fine as long as you're right there to witness administration and you "prepared" the medication. I had a patient who refused to take her PO blood pressure medication unless the CNA gave it to her. The patient's SBP was over 210.
...same thing with family. If I prepare it and I'm standing by, the family can hand it to the patient. Ive never heard of that being a problem.
Where I have worked, the policy was that meds could not be left at the bedside without a doctor's order stating this is admissible. Visitors and family members of other patients will frequently turn in a nurse or nursing assistant for doing something questionable. One should always be especially careful when third parties are present, especially if those third parties make comments. Your feelers should have been energized when the lady made that comment.
TheGooch
775 Posts
Touche!