AFGE Local 1822 and VA Medical Center Waco (Authority decision, August 3, 1982)

Final FLRA decision. This is a final Authority order. An aggrieved person may seek judicial review by filing a petition in an appropriate United States court of appeals within 60 days after issuance under 5 U.S.C. § 7123(a). Filing a petition does not stay the Authority's order unless the court orders a stay under 5 U.S.C. § 7123(c).

Plain-English summary

AFGE Local 1822 proposed procedures for reporting medication incidents and errors at the Waco VA medical center. The Authority held that the proposal conflicted with duties already assigned to nursing coordinators or their designees, including classification and reporting of incidents. It dismissed the petition on the merits.

Decision snapshot

• Authority: 5 U.S.C. § 7106(a)(2)(B).
• Outcome: Medication-reporting proposal held nonnegotiable; petition dismissed.
• Key point: The proposal would redirect work assigned to nursing coordinators.

Full text (FLRA public release)

[ 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 IN THIS
CHAPTER SHALL AFFECT THE

AUTHORITY OF ANY MANAGEMENT OFFICIAL OF ANY AGENCY--

. . . .

(2) IN ACCORDANCE WITH APPLICABLE LAWS--

(A) . . . TO SUSPEND, REMOVE, REDUCE IN GRADE OR PAY, OR TAKE OTHER
DISCIPLINARY ACTION

AGAINST SUCH EMPLOYEES.

/3/ THIS APPENDIX INCLUDES NSB NO. 80-05 AND ITS ATTACHED MEDICATION
ERROR DEFINITION AND CLASSIFICATIONS BUT NOT THE MEDICATION INCIDENT
QUESTIONNAIRE WHICH IS NOT RELEVANT TO THE DISPOSITION OF THIS CASE.