[JuliaS]

I'm not sure where to post this, but I do have a question. My mother is currently in her small town hospital, DX: N/V, dehydration. She is a 10+ year heart transplant recipient, secondary post-ileostomy patient and IDDM. I realize that she has a lot of things going on with her health. This past weekend, we had a couple of problems with the night nurses not properly giving her cylcosporine.
On Friday night, the night nurse attempted to give (1) 25mg Neoral, when the order clearly stated 75 mg (3 of 25mg Neoral). When mother questioned the nurse, she became quiet rude insisting that she was giving the proper dosage, and I intercepted and requested that she double check the order. She did and came back in and gave the ordered dosage, but was snippy about it. Then last night (Saturday), a different nurse was her caregiver. Mother requested three separate times for her cyclosporine to be given, the nurse stated that she had given it already. I was not there, I live 45 miles away, but my dad was. Mom and dad both said that it slipped their mind after mother became very nauseated and her ileostomy bag came loose and had to be replaced.
We have to supply the Neoral since this hospital does not supply it. We only take 6 X 25mg Neoral each day, 3 for the am dose and 3 for the pm dose. When dad arrived at the hospital this morning, 3 Neoral were laying on top of the medication cart outside mothers door. They had mothers name on them. Dad had today's dosages in his pocket.
When talking with the charge nurse today about this, the charge nurse mentioned that the nurse last night had documented that the Neoral had been given.
My question is, how far do I go with this? The charge nurse had not notified the physician yet, had not informed the house supervisor (as per that facility procedure).
I do not work at this facility, but I do know most of the staff there.

[JuliaS]

I should clarify why I'm so upset about this (other than this being my mom) is that I feel that this is false documentation, and the feeling that the staff is attempting to "brush this under the rug".
I don't want to get anyone into trouble, but I feel that this does need to be addressed.
Mother has been in rejection several times over the course of the years (the usual reason being not given her cyclosporine while in the hospital).

[cassioo]

at our hospital if the doc writes take home meds then the pt takes their own home meds and tells us when it's been taken...it's not a huge problem on my floor as it's only a couple of meds most of the time. I don't do the setting up meds with pts names myself if they are in my hand I go give them with MAR inhand (as everyone should everytime) Is there a pt rep to talk to about your concerns?

[JuliaS]

Thank you Cassioo for your reply. At this hospital, even though we supply the cyclosporine, we have to give it to the nurses and then they give and document it. I spoke to the DON and she investigated it and realized that the Saturday dose was not given at all even though it was documented. The way they do it there is document when we give them the meds, how many, the strength, etc. and then document when it was given, how many are left, etc.
I do the same as you do when giving meds, I have the meds and the MAR in hand, and, as you, I feel that this is the only way to give meds.
Again, thank you for your reply.

[cassioo]

You do see lots of people initial the meds with all intentions of giving it then something else happens ie call light, phone then it gets forgotten. I make the students take the MAR's with them but I know for the 8 weeks of clinical I never saw 1 staff nurse take the MAR with them and I don't see many of my co-workers doing it either.

[nursinghumor]

The most important thing at this point is that your mother gets her medications. To that end, I'd talk to the doctor and ask him to write (patient make keep meds at bedside) and mention the difficulties you've been having with the nursing staff.

Most doctors will write the order without a problem. I would write a letter with specific names, dates and times that there was an issue with her meds being given. Once it is on paper and submitted, they need to respond to it.

You never know, this may not be a new issue. If it turns out that there is a history of problems, they may decide to take corrective action. If it is never documented, the problem can persist for a very long time.

That's a judgement call for you to make.

It is a potentially serious issue and you have every right to be concerned about it.

Andrew Lopez, RN
http://www.4nursing.com

[JuliaS]

Thank you. As I mentioned above, I did speak to the DON and she called me back again this morning. They have had problems with this particular nurse before about not giving meds that was documented.
The reason we were giving the nurses the meds, was the doctor wanted to monitor her cyclosporine levels while she was in the hospital. We thought would be safe.
Even though this is a small hospital, her local doctor reports to her transplant doctor in Dallas at Baylor. Her transplant doctor and local doctor work together for her care.
I was afraid that I had over reacted. I'm just concerned.
Thank you again for your help.