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.
OP, you're in a hole ... you might want to stop digging.
I smiled when you wrote that you learned from the thread and are no longer using that particular shortcut. Good for you! Glad it made sense.
Shortcuts and efficiencies are a survival tool, especially in ltc/rehab settings. I try to ask myself what's the worst that can happen before I try a new strategy to save time and/or my back. I think you're in a very normal place for someone seven months in.
I worked in LTC for two years and it was absolutely unacceptable to leave any sort of medication unattended. The med cart had to be locked if I wasn't standing in front of it, and all medication had to be given/taken and witnessed by me (because I'm the one signing for it) . There is no way I would ever leave a med with an aide, regardless of how much I trusted that aide. It's just not in their scope of practice.
Yeah, I know LTC means you're understaffed and take short cuts where you can make them. I was responsible for 36 residents with only two sides to help me. But there are some short cuts that you just can't take.
I'd say it would likely depend on the situation, but med errors are ALWAYS written up, not as a punitive measure, but as an "incident report," the purpose of which is to identify where the breakdown occurred and prevent it from happening again.
Reason why most med errors are not reported. Scary truth.
I would never "Reported " you ! In my time, I have seen so much and been through so much. Really , LTC ? Senokot ? What's next a flintstone vitamin ? Heck, most LTC need to be shut down anyway. You know what ? I probably would have told you watch it next time -How about that ?
I've worked in LTC floors where we left medications at the beside. However, this was only for completely cognitively aware patients and only if we had an order from their MD in the MAR that it was ok to do so with certain medications. For instance, an elderly patient that was stand by assist or independent of cares who would do her evening Inhaler sometime between dinner and getting ready for bed. It had to be written in the order that this was ok though.
Agree with everyone else. It is outside the scope of practice for a CNA to ensure medication was taken. You have to witness the patient taking the pill.
If you charge that the patient took the Med then you are saying in a legal document that you witnessed them taking the Med.
Say you went to a patient left them at their bedtime bedside in for 3 days in a row they drop the pill on the floor and it rolled under the chair they were sitting in and was never taken.
For three days because of your carelessness they did not get there digoxin.
When they go into afib, develop a blood, clot, and then have a massive stroke it is 100% your fault.
Or she tries to pick up the pill and knocks the cup over. The pill then rolls across the table to her another resident suffering from dementia picks it up and takes it. Then if something happens to the second president you are responsible.
There's lots of ways patients could die because you did not watch someone take a pill.
If I have to walk across the room and turn my back on a patient that edd goes with me.
Besides, there's too many Druggys sickos out there who will swallow anything simply because it looks like a pill on the outside chance it might make them high.
Yes I would have written you up. In fact I would have seriously considered firing you
The fact that you are a new grad and doing this is something to be considered.I learned long ago that it doesnt matter if its senna,tylenol,or oxycontin,you cannot leave it at bedside.Its easy to slip into a pattern of this..I give them a chance to take the med,if they do not for any reason I will take it back to the med cart-at skilled nursing facilities,put it in drawer with patient name and room number and time.Make sure its not going to spill over,or get mixed up with anyone elses..a second med cup and tape/If its narcotics I put it in narc drawer because of the double lock regulation.I pass remainder and go back for a second try.If they still do not take it I toss it and document not taken.I used to stash the meds in patient rooms where I thought no one would find them but I found that I would forget..And I also have come across meds left that way so I know others forget too.
Just know its the law and cover your butt.You cannot force a person to take meds and if you give it your best shot thats all you can do..,non essentials such as vitamins,are always given last.You will learn these things.I would have not reported you but informed you of suggestions to deal with very real issue in ltc with large volumes of patients.Just telling you its not acceptable will not help you to organize and prioritize with those big med passes.5 minutes is a long time to administer a senna and seriously I wish a family member would help but its just going to get you in trouble with that wishfull thinking.
You have to be carefull about your practice its a biggie and if you get labelled as not carefull with med matters it will effect your reputation.The manager may or may not remember how it is to pass the meds.That person did what they had to do.Just learn from it.
Agree with everyone else. It is outside the scope of practice for a CNA to ensure medication was taken. You have to witness the patient taking the pill.
For me that is a yes, and no. Let me explain myself. I do have one resident that is very mistrustful of the nurses, even with advanced dementia he knows who the nurses are thanks to our color coded uniforms and just doesn't like the people in the blue uniforms. The only way to ensure he takes his pills is to have the CNA that he trusts give them to him. I do prepare the meds myself and stand right there while the CNA gives them so I am visually confirming he took the meds before I sign them off. Funny how the CNA is ok but for some reason I am trying to poison him!
So, yes while it is probably not within the scope of practice for that CNA to give those meds I am witnessing the patient take the pill. Sometimes in LTC it becomes necessary to get a little creative. Sometimes that creativity leads to bending the rules a little bit without breaking them.
Specializes in LTC,Hospice/palliative care,acute care.
For me that is a yes, and no. Let me explain myself. I do have one resident that is very mistrustful of the nurses, even with advanced dementia he knows who the nurses are thanks to our color coded uniforms and just doesn't like the people in the blue uniforms. The only way to ensure he takes his pills is to have the CNA that he trusts give them to him. I do prepare the meds myself and stand right there while the CNA gives them so I am visually confirming he took the meds before I sign them off. Funny how the CNA is ok but for some reason I am trying to poison him!
So, yes while it is probably not within the scope of practice for that CNA to give those meds I am witnessing the patient take the pill. Sometimes in LTC it becomes necessary to get a little creative. Sometimes that creativity leads to bending the rules a little bit without breaking them.
Great thought. I will have to check the careplan when I go back to work and update it if needed.
On a funny note, the email notification I received listed your response as: "Aslong as that is replanted that's acceptable." I really had to click as my first thought was "huh?? replanting what?" I wonder how that typo happened. Weird.
heron, ASN, RN
4,661 Posts
OP, you're in a hole ... you might want to stop digging.
I smiled when you wrote that you learned from the thread and are no longer using that particular shortcut. Good for you! Glad it made sense.
Shortcuts and efficiencies are a survival tool, especially in ltc/rehab settings. I try to ask myself what's the worst that can happen before I try a new strategy to save time and/or my back. I think you're in a very normal place for someone seven months in.