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 A colleague acts 

Justin is working with Kelsey for the first time in a few months, and he’s worried about the changes he sees in her. He knows Kelsey’s been dealing with a lot—a marriage breakup and a significant back injury—but her behaviour during the shifts makes him concerned for client safety.  Justin's not sure what to do. He doesn’t want to make an allegation without proof or cause Kelsey to lose her job. But he knows he has a responsibility to ensure the safety of clients by reporting Kelsey’s behaviours to his manager.

What did Justin notice?

Justin noticed Kelsey isolating herself during her breaks, disappearing off the unit several times during the shifts. Once he saw Kelsey going into the visitor bathroom when the staff bathroom was vacant. He also heard Kelsey asking for an assignment change and observed her pulling doses of hydromorphone before her shift had started. Twice Kelsey asked Justin to sign for narcotic wastage that he didn't see, saying she’d discarded it without thinking. He refused.

While Justin was covering during Kelsey’s breaks, two of her patients reported that their pain was poorly managed. Yet when Justin checked to see if he could give them anything, their medication administration records (MARs) showed they were both receiving regular and full doses of their ordered hydromorphone. At the time, it didn’t make sense to him as their pain had been reported as controlled on the previous shift.

When he casually mentioned to other colleagues that he often couldn’t find Kelsey, several of them reported that this had become common behaviour. They shared their concerns about regularly having to cover care for her patients as she took unplanned breaks off the unit. They mentioned that they were covering for Kelsey because they know she’s struggling.

What does Justin do?

He shares his concerns and observations with Marina, the clinical nurse leader. Marina reviews the automated dispensing cabinet (ADC) records and MARs for Kelsey's clients. The review reveals discrepancies and issues for two patients. These discrepancies relate to injectable hydromorphone doses that were either not administered, not documented or were questionable.

Together, Justin and Marina decide they must report this to the patient services manager. Justin carefully documents his observations from the shifts he worked with Kelsey, including dates and details of specific incidents, while Marina documents the findings of her health record audit. They outline their concerns and share their documentation with their manager as soon as possible.

Next: A manager reports >>

What happened to Kelsey? >>

What are my reporting responsibilities? >>

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