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Clean as you go
My mother always told me “clean up as you go.” That was the advice when, as a youngster, I made increasingly chaotic messes in the kitchen developing my skills as a cook. Of course I hung on her every word….. well OK, maybe not, but I have to say that there is a lot of sense in her advice.
Once again I find myself investigating an incident at work that began with a missed dose of medicine. Well two missed doses actually. My questioning and review of the circumstances commenced as usual with the systems of work that were in place at the time. I spoke to the care worker who had uncovered the error and she walked me through her process of handing over the medicines duty to the oncoming shift.
I was horrified to discover there were at least 10 loose, random and badly completed medicines administration sheets in each service user’s folder. I asked her why this was, and she replied that she had asked the same question many times of her team leader and nothing was ever done.
The following morning, due to a sudden and serious staff shortage, I found myself holding the keys on that same unit and faced with a medicines round for the first time in about a year. I have to add here that as a registered nurse I would never take on a task I felt I could not safely achieve, but it took me 20 minutes to decipher the pickle that was the MAR folder and this resulted in delays for everyone.
I immediately demanded the staff undertake an audit of the MAR sheets against the standard in our medicines administration protocol. This is clear about how the sheets must be written, recorded, stored and managed. The result was to establish a tidy, clear and unambiguous record for everyone.
This situation served to illustrate the need for organisation in all areas of care delivery. It is important that care workers are trained to be meticulous about record keeping and the need to retain a clear work area, in every area. There is great benefit in establishing a minimum standard for how you record care such as medicines administration, even down to the use of specimen records as training aids. These legal records are the evidence of quality care and could, in extreme circumstances, save your bacon.