On April 11, 2011, I had the opportunity to work with Joe closely as we were passing medications on his two preassigned patients. Listed below are deficiencies I have noted regarding Joe\'s delivery of care to his assigned patients. 1. Joe was prepared to give KCl to a patient with a K of 5.5. (I did prompt him several times to make sure if he wanted to administer the medication.) 2. An order was written at 815 AM to administer 300 mg of Venofer IV prior to discharge. I instructed Joe to research the medication and instructed him to get the piggy back set up ready. at 10 AM , the IV set up was still not primed and he was not able to verbalize any information on Venofer. At that time I handed him my IPOD for him to research the medication. 3. Joe was prepared to give meds to a patient who was NPO. 4. Joe had to be reminded to wipe off IV ports with alcohol prior to connecting the secondary set up. 5. A patient was medicated with hydrocodone for pain at 9:15 for back pain 9/10. Joe was instructed to reassess the pain and respiratory status at 10;15 as per hospital policy. At 10:45 I asked Joe about his assessment findings. He admitted he never reassessed the pain as instructed. I had my self done the assessment at 10:15 but Joe was unaware of this. The patient stated to me her pain was 7/10 and that it was better and she did want anything else for pain. The patient stated to me that is the lowest it usually goes. Upon reviewing Joes note for the day, he stated he reassessed the pain at 10 (which he did not) and that the patient stated the pain was all gone (which it wasn\'t). 6. Upon giving Lovenox to his patient, I noticed she had a large 4 inch by 10 inch ecchymotic area over her upper abdomen and that her abdomen was firm but non tender on the left side. When I questioned Joe, he stated he did not notice the abnormalities. 7. Joe ambulated his patient to the bathroom and assisted her back to the chair to wait for the ambulance which was taking her back to Highland Manor. I happen to be in the room when it came and began to assist her to the wheelchair. I had noticed a large amount of feces on her gown and she had a clean, dry depends on. Joe walked in the room and I asked him if her gown was like this when he ambulated her back to the chair. He stated yes but it was not that large before. I instructed him to get a clean gown and informed him that we never leave a patient in that condition under any circumstances. We also never transfer a patient to another facility in that condition. Based on the numerous issues Joe has had in clinical I do not feel he is able to safely and competently able to care for patients and I am failing him at mid level. This will constitute Joe being dismissed from the program. I feel he lacks the basic level of critical thinking and assessment skills and has no sense of urgency with anything in the clinical setting.
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