Would You Report Me for This?

[cupquake]

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.

[BuckyBadgerRN, ASN, RN]

It's one thing to leave a senna next to a patient/resident in their own private room, quite another to leave it next to a patient/resident in a group setting. Both are technically wrong, but what it someone other than the intended swallowed that pill? True, the "worst" that could happen in an unexpected code brown, but that's not the point.

It's also incredibly unfair for you to expect an aide to follow up on what is technically YOUR duty. Just don't do what you did. Ever.

[Anna Flaxis, BSN, RN]

No, if I were your supervisor I would not write you up for this, but I would counsel you to not make a habit of this and explain the reasons why, and I would document this conversation to cover my own behind.

[AcclrtdBSNstudent]

Hello there.

You mentioned:

"She usually does take the pill, if she does not, I will follow up and be back to make sure she does"

1. An older adult patient w/ dementia has an order for a drug, you are very busy and have 50 more drugs to pass. The patient takes a while to give meds to. What is the best response?

A. Leave the drug with the NA/CNA to give the patient.

B. Give the drug to the family since the patient is sleeping. They can give it later.

C. These options sound crazy so why not just throw the med on the floor and call it a day.

D. Assure safe med administration every time and ensuring your pt takes the med.

Im not making fun of you, so i hope you don't think that. I think your instinct may have told you already something about it wasn't right and you've been thinking about it.

Remember, you and I, are patients too. If I have the honor of taking care of you someday, I know 100% you would expect and would want to TRUST I am doing what is best for you.

Don't beat yourself up though. Learn from it, and always think of situations you are unsure of : "am I risking my license? Am I letting my patient down somehow?"

:)

:)

Sent from my iPhone using allnurses.

[VANurse2010]

I have never worked LTC. I personally think there's nothing wrong with letting an aide watch a pt take a senokot at mealtime provided that there are no swallowing difficulties.

My family member was in ltc for years due to dementia. The aides were very trustworthy and the care was excellent. I would not have had an issue if one of them supervised my family member taking a senokot at mealtime.

The DON may just be concerned about appearances. She may have needed to document something in case this visitor makes a report to an outside agency.

I think you need to shake this off and be careful around this visitor in the future.

In reality world, no, it shouldn't. In crazy health care world and even loonier LTC world, it's a mortal sin.

[Adele_Michal7, ASN, RN]

Yes, I would have.

On my unit, if we have patients who insist on bedside meds being left- we get a doctor's order for it.

[heron, ASN, RN]

It's a mortal sin because people can die as a result of taking an inappropriate pill.

OP - this is a normal learning experience for someone at your stage of the game. Do take it seriously but don't flog yourself over it.

[Annie Wilkes RN]

What's done is done. I would have pulled you aside, told you not to do this anymore, and moved on. THEN, had you ever done this ever again, THEN I would have written the incident up. That's just me. We all make mistakes. LEARNING from those mistakes is what I feel is important. Leaving senokot is not a big issue, as far as I am concerned. Had it been a narcotic, a heart med, etc then it would have been a bigger offense.

[VANurse2010]

It's a mortal sin because people can die as a result of taking an inappropriate pill.

OP - this is a normal learning experience for someone at your stage of the game. Do take it seriously but don't flog yourself over it.

It depends on what it is whether they're going to die.

Look - she clearly isn't following standard of care, but let's not get overly dramatic about.

[Anna Flaxis, BSN, RN]

Look - she clearly isn't following standard of care

I don't think that's clear.

In an outpatient setting, i.e. when the people are in their own home, as it is with LTC residents, the role of the RN is often to simply witness or facilitate self-administration of medications. Even CNAs can do this.

I would think that whether or not she is following standard of care would depend upon the individualized plan of care for that resident.

I think it's ridiculous, in any case, to get raked over the coals over a Senokot.

Again, counseling as to why it may not be prudent to leave a medication with a resident and walk away would definitely be in order, but I think disciplinary action is taking things a bit to the extreme, unless this particular RN has demonstrated a pattern of careless practice.

[TheCommuter, BSN, RN]

Would you write me up for this?

Although I would not write you up for this incident, I must mention that you exercised suboptimal judgment in this situation.

I worked in LTC facilities for six years, so I know about all of the shortcuts that occur in these places. My advice is to never, ever, never challenge a problematic family member. Never, ever take shortcuts around a problematic family member. This is common sense.

In LTC, the family is always right. Remember that!

[Anna Flaxis, BSN, RN]

It's a mortal sin because people can die as a result of taking an inappropriate pill.

A Senokot?

[joanna73, BSN, RN]

If the resident is not prepared to take the medication, you could take the medication with you and then attempt again. Medication should not be left unattended.