YIKES! ADON calls on my off day!

[BerryHappy]

Ugh. Just got a call from the ADON at the LTC I have been working at for 4 months. It seems that I gave a PRN psychotrohphic to a pt and didn't chart enuf. Ummmm, btw...PSYCHOTROPHICS CANNOT BE PRN?!!! DARN! I didn't know that! YES, it IS in the MAR as a PRN. YES, the pt needed it along with the PRN ativan 'cause she's a Wanderer and fought me to come back into the facility when we found her out in the parking lot. So am I in big trouble? ADON told me because I gave the routine Haldol's along with the PRN Halodol and Ativan, it looks like I was keeping her drugged up all day. She starts sundowning at 2 and was outside by 2:15. Her first routine Haldol is at 9am, I gave her the PRN meds at 2:30pm and then she got her routines at 5pm. I of course gave her the PRN's because of the wandering and aggressiveness, but I think I forgot to chart all that. What burns me up is the DON HERSELF has found this pt in the pkg lot (not my shift) and said she was going to have her put on a different floor (we're on the 1st). Plus, we have pictures at the reception desk of this pt just for when she gets too close to outside. The ADON who called said she would follow up with me at a later date. Darn! Am I in trouble or is the person who made a mistake on the MAR?

Also, why does it seem that the ONLY way for me to learn all the details is by making mistakes!!! DAMN!

[Jules A, MSN]

As you have more experience you will know when the MAR has something that seems a little off and you will verify it with the chart or call the physician. To me this isn't a huge deal...hopefully to your boss it isn't either. :) As for the charting it is important to be very thorough especially when there are prns or unusual s/s present. You will get better at that also. I'd let go of the fact that this pt isn't a great fit for your unit because she is there and you will need to safely care for her as per your facilities guidelines until she is transferred. Hang in there.

[withasmilelpn]

LTC regs are the reason you need to chart more. Anyone who has worked in this field knows that the lady most likely needed it AND the Haldol and we all can recall cases in which NOTHING worked. Psychotropics are considered chemical restraints. Despite poor staffing in nearly all LTC, you may not ever use ANY restraint for the convienence of staff. She has to have a clear convincing need showing agitation and showing all the other interventions you were supposed to do before you ever gave her the pill (assuming you had time to do them, but still no excuse in the minds of the almighty regulators.) Common interventions include offering food and fluids, changing the environment to a calm and quiet one, toileting, engaging in an activity... Sometimes these do work, so I am not knocking them completely. (A good one is letting them call and talk to a family member, I use that a lot.) I would not administer Ativan concurrently with the Haldol so that you can show that the Haldol was ineffective and nonpharmacological interventions didn't work as well so you can justify the Ativan. Also make sure that you document the response to the medication - the goal is to calm her not zonk her out. I would request an inservice from your ADON as to the particular no-nos of medication administration in Long term care, and what their policies are regarding interventions. Most of the medications appear on the Beer's list (sp?)- a list of medications the elderly can have increased side effects, etc. This is the result of poor training on their part, not yours. LTC have to abide by very strict regulations, none of which you would've learned in school. Frankly, I'm surprised she would even be allowed to be on Haldol, never mind the Ativan. (And because of that fact, it tells me that she most likely is very unmanageable often.) Just treat this as a learning experience. Best of luck to you!