Any nurses around this evening please?

[Longhotsummers]

DD is an in patient and is on medication to treat her condition. She had a sudden deterioration yesterday evening which we couldn’t understand as she has been doing so well and today, a doctor told us that her main medication had not been given as it should have been on Thursday and Friday, which was a mistake.
Can someone who works on a ward please explain what checks there should be to ensure a patient has been medicated as per the instructions of the consultant, and as they have been for the past 10 days. The doctor who informed us today was at a loss to understand and said she would investigate but, in the meantime, I’d like to know what standard procedure is please.

Get in touch with PALS

Also - was this put in her notes as well as the verbal explanation? If so take a photo on your phone - you’ll need it. Notes go ‘missing ‘

No, we can't as different hospitals have different processes. Make an appt with the ward manager?

I think this is very common. In my case it was because the nurse has someone else's notes open on the computer and thought it was mine. Definitely check for yourself, every time

Where I work prescription charts are electronic. Medication could be missed if a doctor hasn't written up the prescription, or if a nurse has missed that the drug has been prescribed. There are regular 'drug rounds' where a patients chart would be check during the day. But the omission could be a prescribing omission or a dispensing omission.

I hope your daughter is recovering well now.

There could be several reasons such as it was out of stock and not ordered from the pharmacy in time, or the nurses missed it on the drug chart.

It should also have been recorded on an incident form as a drug error.

Out of interest, what was the medication?

@Frances0911 thank you. I’ve pm’d you. The drug was in stock, had been prescribed but staff “forgot” to give it over two days.

@Longhotsummers are you sure the doctor prescribed them properly?

Im just asking as it’s very difficult to just ‘forget’ to give a medication, especially 2 days in a row, on paper charts or electronic. And even more suspect is that no one picked up on it before this (doctors during rounds would have, or should have noticed a core drug omission, nurses on the next shift would have noticed an unsigned box that says the medication had been given, or the computer would be flagging up that a medication is late/missed, pharmacy who check charts very regularly etc. ). I’m not saying mistakes and omissions don’t happen but I’m just wondering why a core medication omission hadn’t been highlighted sooner.

This, the MAR chart would show this. How olds your daughter is she in paeds or adult hosp?

Every trust/hospital different ways of treatment.

Ask at the ward.

@ExcitingTimes2023 thanks. She has been on them since early last week. The dose was upped on Tuesday and was given at the increased dose correctly on Tuesday and Wednesday.
That’s exactly what I’m wondering given everything is electronic that surely it would have been flagged and noted either by the night staff who should have given them to DD, or noticed in the morning by the day team. The Dr today was clear that two doses over two days had been missed.

@DoreenonTill8 Young adult patient.
@MumChp I will but wanted to have an idea of normal procedure before I raise it. She’s been offered incorrect doses of other medications recently and luckily has noticed beforehand but wasn’t well enough to realise this one had been missed twice altogether.

Ask if there was a clinical reason it was omitted. Or speak to the nurse in charge/ ward manager. We can't advise specifically, as all hospice different procedures. How old is DD? Makes a difference if she's on adults or paediatrics.

This is not allowed.

I can't really understand this either. If this had happened at my former workplace, the nurse from the night shift would have got a phone call to check if the drug had been given and not signed for (then a datix completed) or if the drug had not been given (then a datix completed). It would show as missed.

@Lougle same on my ward.

This would be impossible in our ward unless the doctor did not prescribe the drug on the online meds chart. This happens quite frequently btw. Just today, I had two patients who weren't prescribed all of their medications. These were adults though so they were able to query with me why they weren't getting certain Meds and then I could go to the relevant doctors and request for the prescriptions to be changed. Meds charts are usually set up by junior doctors, not consultants though.

Meds get missed out on on our ward if they haven't been prescribed on the online system or if there is no ward stock. No ward stock also happens daily. I never have all medications for all my patients. I love it when they bring all their own meds into hospital.

If a drug has been prescribed (in hospital and not just before the admission) and hasn't been given, the online system will keep sending notification. It really can't be missed.

That's how it works for us at least. We use a system called Hepma.

It's unusual for a nurse to just forget, was it a night time drug or early morning drug that the night staff should gave given and wasn't signed for and nobody noticed to check.

Is she detained/on a MH ward?

What medication is it, usually a nurse reads the chart, gives it, signs they've given it, that's assuming it was properly prescribed, in stock, the patient was able to take it, agreed to take it, the nurse was trained in medication administration. The ward manager can ask the nurse who was on shift what happened if there's nothing written in the noted.

Exactly this. Wether a paper or electronic chart a missed medication is blazingly obvious and stands out like a sore thumb.

Who said the nurse forgot to give the medication. The staff wouldn't know that unless they spoke to the nurses, or the nurses admitted it. A daytime doctor would have no contact with a night duty nurse.

I did for my dad when we had serious issues at a hospital. I had to complain and I was told that they didn’t know the dr in duty that day and also denied the incident and when I did a request for notes - pages were ‘missing’ I was then able to show that I had the missing notes and I was able to give the name of the dr - they weren’t happy and had to back down

What is not allowed? Notes going missing or taking a photo?

They left the notes in the room it wasn’t as if we accessed them when we weren’t meant to, it shouldn’t be an issue to view / photograph notes unless they have someone to hide !