09:0709(85)NG - AFGE Local l822 and VA Medical Center, Waco, TX -- 1982 FLRAdec NG



[ v09 p709 ]
09:0709(85)NG
The decision of the Authority follows:


 9 FLRA No. 85
 
 AMERICAN FEDERATION OF GOVERNMENT
 EMPLOYEES, LOCAL 1822, AFL-CIO
 Union
 
 and
 
 VETERANS ADMINISTRATION MEDICAL
 CENTER, WACO, TEXAS
 Agency
 
                                            Case No. O-NG-362
 
                 DECISION AND ORDER ON NEGOTIABILITY ISSUE
 
    THE PETITION FOR REVIEW IN THIS CASE COMES BEFORE THE FEDERAL LABOR
 RELATIONS AUTHORITY (THE AUTHORITY) PURSUANT TO SECTION 7105(A)(2)(E) OF
 THE FEDERAL SERVICE LABOR-MANAGEMENT RELATIONS STATUTE (THE STATUTE),
 AND RAISES THE QUESTION OF THE NEGOTIABILITY OF THE UNION'S PROPOSED
 CHANGES TO A REVISED NURSING SERVICE BULLETIN NO. 80-05 (NSB NO. 80-05)
 ISSUED BY THE AGENCY, CONCERNING THE REPORTING OF MEDICATION "INCIDENTS"
 AND "ERRORS" FOR NURSING SERVICE PERSONNEL.  (SEE APPENDIX.)
 
                              UNION PROPOSAL
 
    PURPOSE
 
    TO DEFINE ACTIONS TO BE TAKEN IN REPORTING INCIDENTS/ERRORS IN
 ADMINISTRATION OF
 
    MEDICATION.
 
    POLICY:
 
    INCIDENTS/ERRORS IN ADMINISTERING MEDICATION MUST BE REPORTED
 IMMEDIATELY AND IMMEDIATE
 
    ACTION TAKEN FOR PATIENT'S SAFETY AND WELFARE, AS APPROPRIATE.
 
    PROCEDURE:
 
    REPORT, IMMEDIATELY, ALL MEDICATION INCIDENTS/ERRORS TO THE NURSE
 COORDINATOR, TO THE
 
    NURSING SUPERVISOR, AND TO THE WARD PHYSICIAN AND/OR MEDICAL O.D., AS
 APPROPRIATE.
 
    THE NURSE COORDINATOR ON EACH NURSING UNIT IS RESPONSIBLE FOR
 INITIATION OF VA FORM
 
    10-2633, AFTER HER INVESTIGATION OF THE INCIDENT.
 
    MEDICATION ERROR:  (DEFINITION)
 
    WHEN A PATIENT RECEIVES MEDICATION NOT PRESCRIBED BY A PHYSICIAN OR
 DENTIST.
 
    CLASSIFICATIONS:
 
    PRIMARY:  1.  MEDICATION ERROR CAUSED BY FAILURE TO FOLLOW PROPER
 PROCEDURE.
 
    2.  A PROCEDURE CARRIED OUT INCORRECTLY CAUSING ANOTHER PERSON TO
 MAKE AN ERROR.
 
    SECONDARY:  AN INCIDENT RESULTING IN ERROR THAT IS THE DIRECT RESULT
 OF THE INCORRECT
 
    ACTION OF ANOTHER PERSON.  THIS CLASSIFICATION DOES NOT RESULT IN ANY
 FORM OF DISCIPLINARY
 
    ACTION.
 
    UPON CAREFUL CONSIDERATION OF THE ENTIRE RECORD, INCLUDING THE
 PARTIES' CONTENTIONS, THE AUTHORITY MAKES THE FOLLOWING DETERMINATIONS.
 AS PREVIOUSLY NOTED, NSB NO. 80-05 CONCERNS THE REPORTING OF MEDICATION
 INCIDENTS AND ERRORS FOR NURSING SERVICE PERSONNEL.  SPECIFICALLY, IT
 REQUIRES NURSING SERVICE PERSONNEL TO PROVIDE MANAGEMENT WITH
 INFORMATION IN CONNECTION WITH THE PERFORMANCE OF THEIR WORK.  THIS
 INFORMATION INDICATES WHETHER ASSIGNED WORK HAS BEEN CORRECTLY
 PERFORMED
 AND, THUS, IS ESSENTIAL TO THE CONDUCT OF HEALTH CARE OPERATIONS AS WELL
 AS RELEVANT FOR THE PURPOSE OF TAKING DISCIPLINARY ACTION BASED UPON
 ERRORS IN THE ADMINISTRATION OF MEDICINE.  IN THIS REGARD, THE UNION'S
 PROPOSAL IS INCONSISTENT WITH THE AGENCY'S ASSIGNMENT OF CERTAIN PATIENT
 HEALTH CARE MONITORING DUTIES TO NURSING COORDINATORS OR THEIR
 DESIGNEES, WHICH ASSIGNMENT IS REFLECTED IN NSB NO. 80-05.  THESE DUTIES
 INCLUDE THE CLASSIFICATION OF MEDICATION INCIDENTS AND ERRORS, AND THE
 COMPLETION OR FORWARDING OF QUESTIONNAIRES AND REPORTS INVOLVING SUCH
 MATTERS.  CONSEQUENTLY, THE PROPOSAL WOULD VIOLATE MANAGEMENT'S RIGHT TO
 ASSIGN WORK UNDER SECTION 7106(A)(2)(B) OF THE STATUTE.  /1/ SEE
 AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES, AFL-CIO AND AIR FORCE
 LOGISTICS COMMAND, WRIGHT-PATTERSON AIR FORCE BASE, OHIO, 2 FLRA 603
 (1980) (PROPOSAL XI), ENFORCED AS TO OTHER MATTERS SUB NOM., DEPARTMENT
 OF DEFENSE V.  FEDERAL LABOR RELATIONS AUTHORITY, 659 F.2D 1140 (D.C.
 CIR. 1981), CERT. DENIED SUB NOM., AFGE V. FLRA, .  . . U.S. . . ., 102
 S.CT. 1443 (1982).
 
    FURTHER, INSOFAR AS THE UNION'S PROPOSAL WOULD HAVE THE EFFECT OF
 MODIFYING THE SUBSTANTIVE CRITERIA FOR TAKING DISCIPLINARY ACTION UNDER
 NSB NO. 80-05, IT MUST BE FOUND TO BE VIOLATIVE OF MANAGEMENT'S RIGHT TO
 DISCIPLINE EMPLOYEES PURSUANT TO SECTION 7106(A)(2)(A) OF THE STATUTE.
 /2/ IN THIS REGARD, THE RECORD SHOWS THAT THE UNION'S PROPOSAL WOULD
 DIRECTLY INTERFERE WITH THE AGENCY'S DISCIPLINING NURSING SERVICE
 PERSONNEL FOR CERTAIN TYPES OF INFRACTIONS IN THE ADMINISTRATION OF
 MEDICINE BY NARROWING THE DEFINITION OF, AND THUS THE RESPONSIBILITY
 FOR, MEDICATION ERRORS.  THAT IS, UNDER THE UNION'S PROPOSAL CERTAIN
 ERRORS IN THE ADMINISTRATION OF MEDICINE, SUCH AS INCORRECT FORM OR
 DOSAGE, IMPROPER INTERVALS, AND INCORRECT ROUTE AND DOSE, WOULD BE
 ELIMINATED AS POSSIBLE GROUNDS UPON WHICH THE AGENCY, PURSUANT TO NSB
 NO. 80-05, COULD COUNSEL, ADMONISH, REPRIMAND, SUSPEND, OR TAKE OTHER
 DISCIPLINARY ACTION AGAINST AN EMPLOYEE, BECAUSE SUCH ERRORS WOULD NO
 LONGER CONSTITUTE MEDICATION INFRACTIONS.  SEE DEPARTMENT OF DEFENSE V.
 FLRA, 659 F.2D 1140, 1159-61.
 
    FINALLY, THE UNION'S CLAIM THAT ITS PROPOSAL IS INTENDED SOLELY TO
 CLARIFY REPORTING PROCEDURES OF NURSING SERVICE PERSONNEL CANNOT BE
 VIEWED AS DISPOSITIVE IN LIGHT OF THE LANGUAGE OF THE PROPOSAL AS
 DRAFTED WHICH CLEARLY IS NOT LIMITED TO SUCH CLARIFICATION.  OF COURSE,
 IF THE UNION WERE TO CONFORM ITS PROPOSAL TO ITS STATED INTENT, SUCH
 PROPOSAL WOULD BE WITHIN THE DUTY TO BARGAIN.
 
    ACCORDINGLY, PURSUANT TO SECTION 2424.10 OF THE AUTHORITY'S RULES AND
 REGULATIONS (5 CFR 2424.10 (1981)), IT IS ORDERED THAT THE UNION'S
 PROPOSAL BE, AND IT HEREBY IS, DISMISSED.  ISSUED, WASHINGTON, D.C.,
 AUGUST 3, 1982
 
                       RONALD W. HAUGHTON, CHAIRMAN
 
                       HENRY B. FRAZIER III, MEMBER
 
                        LEON B. APPLEWHAITE, MEMBER
 
                     FEDERAL LABOR RELATIONS AUTHORITY
 
                               APPENDIX /3/
 
                  VETERANS ADMINISTRATION MEDICAL CENTER
 
                                WACO, TEXAS
 
 NURSING SERVICE BULLETIN NO. 80-05 TO:  ALL NURSING SERVICE PERSONNEL
 FROM:  CHIEF, NURSING SERVICE SUBJ:  REPORTING MEDICATION
 INCIDENTS/ERRORS 1.  PURPOSE:
 
    TO DEFINE ACTIONS TO BE TAKEN IN REPORTING INCIDENTS/ERRORS IN
 ADMINISTRATION OF MEDICATION.  2.  POLICY:
 
    INCIDENTS/ERRORS IN ADMINISTERING MEDICATION MUST BE REPORTED
 IMMEDIATELY AND IMMEDIATE ACTION TAKEN FOR PATIENT'S SAFETY AND WELFARE.
  3.  PROCEDURE:
 
    A.  REPORT, IMMEDIATELY, ALL MEDICATION INCIDENTS/ERRORS TO THE
 REGISTERED NURSE "IN
 
    CHARGE," TO THE NURSING SUPERVISOR, AND TO THE WARD PHYSICIAN AND/OR
 MEDICAL O.D., AS
 
    APPROPRIATE.
 
    B.  THE NURSE COORDINATOR OR DESIGNEE ON EACH NURSING UNIT IS
 RESPONSIBLE FOR THE OBJECTIVE
 
    CRITIQUE AND CLASSIFICATION OF EACH MEDICATION INCIDENT/ERROR TO
 ASSURE THAT THESE ARE CHARGED
 
    TO THE PERSON(S) RESPONSIBLE AND FOR INITIATION OF VA FORM 10-2633.
 
    (1) REVIEW THE INCIDENT AND CLASSIFY ACCORDING TO THE ATTACHED
 DEFINITIONS/CLASSIFICATIONS.
 
    (2) COMPLETE PART III OF THE MEDICATION INCIDENT QUESTIONNAIRE.
 
    (3) FORWARD THE COMPLETED VA FORM 10-2633 AND MEDICATION INCIDENT
 QUESTIONNAIRE, THROUGH
 
    CHANNELS, TO THE CHIEF, NURSING SERVICE.
 
    (C) THE REGISTERED NURSE AND/OR LICENSED VOCATIONAL NURSE INVOLVED IN
 THE INCIDENT/ERROR
 
    WILL COMPLETE PART I OF THE MEDICATION INCIDENT QUESTIONNAIRE.
 
    D.  THE REGISTERED NURSES "IN CHARGE" WILL COMPLETE PART II OF THE
 MEDICATION INCIDENT
 
    QUESTIONNAIRE.
 
    E.  THE NURSING SUPERVISOR/NURSING OFFICE WILL COMPLETE PART IV OF
 THE MEDICATION INCIDENT
 
    QUESTIONNAIRE.
 
    4.  COOPERATIVE ACTION(S), AS INDICATED, WILL BE TAKEN BASED ON THE
 INFORMATION REPORTED AND THE CIRCUMSTANCES OF THE INCIDENT/ERROR:
 
    A.  VERBAL COUNSELLINGS WILL BE GIVEN BY THE NURSE COORDINATOR OR
 DESIGNEE.
 
    B.  WRITTEN COUNSELLINGS WILL BE GIVEN BY THE NURSING SUPERVISOR AND
 WILL BE FILED IN THE
 
    OFFICIAL PERSONNEL FOLDER.
 
    C.  REVIEW CLASSES WILL BE CONDUCTED BY NURSING EDUCATION AND
 RECORDED.
 
    D.  DISCIPLINARY ACTION(S) (ADMONISHMENT, REPRIMAND, SUSPENSION) WILL
 BE TAKEN BY THE
 
    CHIEF, NURSING SERVICE, OR DESIGNEE, AND FILED IN THE OFFICIAL
 PERSONNEL FOLDER.
 
    5.  RESCISSION:  NURSING SERVICE BULLETIN NO. 78-29, "REPORTING
 MEDICATION ERRORS," DATED NOVEMBER 1978.
 
                           MARY J. HAYNIE, R.N.
 
                          CHIEF, NURSING SERVICE
 
 INDEX AND FILE UNDER "M" IN ADMINISTRATIVE MANUAL.
 
              MEDICATION ERROR DEFINITION AND CLASSIFICATIONS
 
    THESE DEFINITIONS AND CLASSIFICATIONS ARE TO BE USED IN THE
 CONSISTENT, OBJECTIVE, ASSIGNMENT OF INCIDENTS/ERRORS TO INDIVIDUALS
 RESPONSIBLE FOR THEIR OCCURRENCES.  I.  DEFINITION
 
    A.  MEDICATION ERROR.  (1) ANY INCIDENT OF DEVIATION FROM THE
 PROTOCOLS ESTABLISHED FOR
 
    INDIVIDUALS RESPONSIBLE FOR ADMINISTERING MEDICATIONS TO PATIENTS.
 (2) ANY DEVIATION FROM
 
    ESTABLISHED PROTOCOLS WHEREIN A PATIENT (A) DOES NOT RECEIVE
 MEDICATIONS EXACTLY AS
 
    PRESCRIBED, I.E., INCORRECT FORM/DOSAGE, AT INCORRECT INTERVALS,
 INCORRECT ROUTE, INCORRECT
 
    NUMBER OF DOSES;  (B) RECEIVES MEDICATIONS NOT PRESCRIBED, I.E.,
 MEDICATIONS WITHOUT A DOCTOR'S
 
    ORDER.  II.  CLASSIFICATIONS
 
    A.  PRIMARY.  CLASSIFICATION OF AN INCIDENT CREDITED (CHARGED) TO THE
 ACTIONS OF THE FIRST
 
    PERSON ACCOUNTABLE FOR A CORRECT ACTION.  TWO (2) OR MORE PRIMARY
 ERRORS MAY BE MADE ON THE
 
    SAME ORDER;  THE TRANSCRIBER, VERIFIER AND VALIDATOR OF AN ORDER MAY
 ALL ACT IN ERROR.
 
    B.  SECONDARY.  CLASSIFICATION OF AN INCIDENT RESULTING IN ERROR THAT
 IS THE DIRECT RESULT
 
    OF THE INCORRECT ACTION OF ANOTHER PERSON, I.E., (1) A SECONDARY
 INCIDENT WHEREIN INCORRECT
 
    MEDICATION IS ADMINISTERED ACCORDING TO ORDERS THAT HAVE BEEN
 INCORRECTLY
 
    TRANSCRIBED/VERIFIED/VALIDATED BY ANOTHER PERSON.  (2) A SECONDARY
 INCIDENT WHEREIN
 
    MEDICATIONS ARE ADMINISTERED ACCORDING TO ORDERS THAT HAVE BEEN
 CHANGED/DISCONTINUED, WITH
 
    FAILURE OF THE ACCOUNTABLE INDIVIDUAL TO APPROPRIATELY NOTIFY THE
 PERSON ADMINISTERING THE
 
    MEDICATION(S).  III.  OTHER CONSIDERATIONS
 
    A.  ACCOUNTABILITY.  INCIDENTS RESULTING IN A PATIENT'S RECEIVING
 MEDICATION IN ERROR DUE
 
    TO FAILURE OF THE RESPONSIBLE INDIVIDUAL TO (1) SEEK
 CLARIFICATION/INTERPRETATION OF ORDERS
 
    THAT ARE NOT CLEAR;  (2) ASSIGN PERSONNEL TO ADMINISTER MEDICATIONS;
 (3) ACCEPT RESPONSIBILITY
 
    FOR APPROPRIATE ACTION.
 
    B.  CHARTING.  INCIDENTS RESULTING IN IMPROPER DOCUMENTATION OF
 ACTIONS BUT WHERE PATIENTS
 
    RECEIVED MEDICATION(S) AS PRESCRIBED.
 
 
 
 
 
 --------------- FOOTNOTES$ ---------------
 
 
    /1/ SECTION 7106(A)(2)(B) PROVIDES:
 
    SEC. 7106.  MANAGEMENT RIGHTS
 
    (A) SUBJECT TO SUBSECTION (B) OF THIS SECTION, NOTHING IN THIS
 CHAPTER SHALL AFFECT THE
 
    AUTHORITY OF ANY MANAGEMENT OFFICIAL OF ANY AGENCY--
 
   .          .          .          .
 
 
    (2) IN ACCORDANCE WITH APPLICABLE LAWS--
 
   .          .          .          .
 
 
    (B) TO ASSIGN WORK . . . .
 
    /2/ SECTION 7106(A)(2)(A) PROVIDES:
 
    SEC. 7106.  MANAGEMENT RIGHTS
 
    (A) SUBJECT TO SUBSECTION (B) OF THIS SECTION, NOTHING I