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 work in ltc, too - and still think it's a very dangerous move, I don't care how many residents you pass meds to. (Night shift here - my load is 58). I'm more likely to label the med and stash it, and catch the resident on my way back down the hall (technically "pre-pouring).
One of the things experience teaches you is which rules you can break.
Specializes in Oncology; medical specialty website.
How can you be certain the patient takes the pill? Just because it's not there doesn't mean she took it.
That is poor nursing practice. If I were your supervisor, I would write you up for sure. This is sloppy medication administration. Don't do this again.
If the task is not one that your state board says can be delegated to unlicensed personnel, then you cannot leave a medication with a patient and ask an aide to assure the patient takes it.
Leaving any medication unattended with any patient in any setting where you are responsible for signing that the patient took the medication is a dangerous practice.
I wouldn't write you up, but I would say something about it to you directly. I hate finding pills in patients' beds and having no idea what they are or why they're there. If the patient doesn't want to take their medication, I'll leave and take it with me. If it's something important, I'll re-attempt.
I guess I would have to write you up because you shouldn't leave medications at the bedside, especially of a dementia patient and knowing that there was a family member right in front of you. The fact that you still don't see anything wrong this is troublesome. I was taught that the only way you can leave medications at the bedside is if the person is A&Ox4 which a dementia patient is not! Also, for future reference narcotics are never to be left at the bedside EVEN if the patient is A&Ox10
However, it wasn't very smart of you to say that and do it in front of a known problem family member. This is where common sense comes in. You got caught and reprimanded for doing something obviously wrong, but that many others do. When you take shortcuts and get caught you have to suck it up and accept consequences.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Here is another angle to the scenario------it's the potential danger you cause by leaving meds unattended for patients or nursing home residents.
True story: A good friend's father was in a nursing home at the end of his life. Her child, who was just 3 or 4, picked up an unidentified pill on the floor and swallowed it before mom could stop her. Now, should that child have been on the floor? No, she should not have been, and my friend felt sorry about that. She put her down and the kid scooted right under the bed and grabbed up the pill and ate it in like a second flat. That there was a pill lying around for a toddler to eat was bad enough; no one knew WHAT medication it was---- so off to the ER to have her child checked out and observed overnight. Fortunately, the child was unharmed. But it could have been bad, very bad, if it were the wrong drug.
Point? Do NOT leave meds at the bedside of ANY SORT for ANY REASON. You have no idea their disposition once you do. So yea, it is a really big deal what you did.
I feel like maybe a verbal coaching or counseling would be appropriate here. Something doesn't sit right with me on how you engaged this other family member on, "oh she usually does take it"....like I wouldn't discuss another patient's habits or actions with an outside party. I agree with minding your Ps and Qs with families with known history.
Leaving the med at the bedside is unquestionably negligence. If I visited a loved one at a nursing home and saw that one of his nurses carelessly left medication lying around, I would definitely report that nurse. The fact that you're defiantly questioning this write up shows your immaturity. Instead of admitting that you did something wrong and thinking of ways to improve yourself, you're blaming everyone but yourself. We all make mistakes. Own up to them and grow.
You were definitely in the wrong here. As your co-worker I would not have written you up but would have advised you not to leave meds at the bedside. As your manager, after a family member complaint, I would be forced to write you up in case that family member reported the incident to the state. I would need to have the incident documented and show that action was taken to correct it. Try not to blame your manager too much, she really had no choice but to write you up. And she's right that it's poor practice.
I have worked in LTC and I know how little time you have to pass meds to all the residents. I found it nearly impossible to get the med pass done on time while still following all the rules. However, I always made sure the meds were actually taken. If you leave a pill at the bedside, another resident may take it. This is one shortcut you really can't take because, as you learned, it will come back to bite you somehow. If the resident is slow to take pills try to convince them to take them in applesauce or pudding so you can just feed it to them and be on your way. If they won't take it right then and there, save it for later and try again. If they still won't take it for you, they have refused that medication and you can document their refusal.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
PS---- I have worked in LTC so I know how hard it is. I had to pass meds for 40-50 residents in short time. But not once, not a single time, did I leave any medication of any type unattended for any reason.
heron, ASN, RN
4,660 Posts
I work in ltc, too - and still think it's a very dangerous move, I don't care how many residents you pass meds to. (Night shift here - my load is 58). I'm more likely to label the med and stash it, and catch the resident on my way back down the hall (technically "pre-pouring).
One of the things experience teaches you is which rules you can break.