We had discussion at work last night about what LPNs responsibilites are as far as giving medication after RN signs it off on MAR. The other RN working with me scolded the LPN because she gave a dose of Potassium without looking up the patient levels. The LPN protested that the fact that the Potassium was signed of on the MAR indicated these things had been checked. I personally think that keep tabs on labs is in the realm of the RN. It might be good idea for LPN to have quick look but I doubt if her license would be in pulled if she gave a dose of Potassium to a patient that had K level of say 7. The RN that signed it off would most likely bare the brunt. The other RN disagreed she said they would blame the RN and LPN. I just don't know.
I think they would both be to blame. Same with med where you check pulse before giving you can't go by the pulse that was taken during routine vitals an hour or 2 before. Even if another RN tells me something I like to check it myself before I do anything. Put like this if the RN signed off on something and another RN was the med nurse that day who would be responsible??? I'd check it myself.
Why is the RN signing the MAR and the LPN is administering the med???
WR,,, three commas for Becca
I thought she ment signed off that she'd seen the lab. Whoever verifies every MAR at 2300 signs the top of ours (usually an LPN) but at that time they are just checking that everything on the new mar was on the old one (doesn't mean something still didn't get not transcribed or faxed to Pharm)
"giving meds after RN signs it off on MAR" meant to me that the RN had signed off the med on the MAR. Like you I don't give meds on someone else's say.
I worked agency years ago and the night RN did all the blood sugars at around 0600 and handed me a piece of paper with ROOM NUMBERS on it. Not even the patient's names and wanted me to give the AM insulin. I told the DON I wouldn't be doing that. She told me that's the way it's always been done and I told her I wasn't gonna do it that way. I didn't work there again and that's alright with me.
Even if an aide at the hospital came and told me someone needed pain med I always went and talked to the patient first. Maybe they needed percocet or maybe they only needed tylenol.
JMHO.
WR,,, three commas for Becca
My opinion. Both are to fault. The RN falsified the MAR by signing off before med was given. My thought on this, If the K+ was 7 depending on the kcl dose they both contributed to the possible demise of the patient. If I had to give a drug, and there were levels drawn. I check them. I don't care what some one else said. It is the patients life and my license. To say, "The RN said it was OK to give the med." will not hold up in a court of law when you are charged for death of the patient. It sounds like a cop out.
I agree with 1mg.epi, I am an LPN and just as responsible as the RN for checking and double checking labs/historys/allergies/test results etc... for the patient that I have been assigned to take care of. Putting all the responsibility on the RN won't wash in court if somthing were to happen to that patient. Rachael
Who signs a MAR before giving a med? That is the first thing we got taught in med administration class: 1)check labs at start of shift 2) the five rights, DDPRT ie: RIGHT drug, dose, patient, rout and time 3)administer med 4)sign off on the MAR.
Sounds like a :eek:"SHORTCUT TO DISASTER" :eek:to me. sure it takes a little bit more time but if it saves a liscence and or a LIFE whats a fiew moments at the start of the shift worth.
In MICHIGAN we have MED LPN's and they are responsible for all meds except IV drugs and hanging blood, that falls on the RN's shoulders. So I don't know if I helped with my lesson in medadmin or maby I miffed a couple of people off, but I need to slow down and keep ME from being tempted to "SHORT SKIRT IT"when it comes to the MAR as well as labs.
"BECAUSE I SAID SO" IS NOT A GOOD ENOUGH REASON.
Most of the MARs I have used have an area where you can note the last Potassium level result.
Usually next to any Potassium dose listed.
I usually chart it on the MAR when I check my meds by the doctor's orders at start of shift.
I was taught this in LPN school, and continue doing it as an RN.
It is a good practice, and I hate to say it, but the lawyer will say,
"Would a prudent nurse check the lab herself before giving the med?"
We heard stuff like that in school until I was sick of it-but it is true.
By the way, I hate the word prudent.
On accuchecks...I check the history on the accucheck monitor because it is listed by patient wristband/barcode number.
:cool:
I was an LVN and I was taught that you are responsible for what you do. Even if the RN said to do it, still check to K+. I was taught the person who gave the med is the person who is ultimately responsible.
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