My pt accused my coworker of taking her Percocets! (long)

[shoegalRN]

Ok, here's the story. I just need a different set of eyes and point of views regarding this issue.

I work nights and I am a new grad. I am in a new grad residency program and in orientation in the SICU. I was assigned two pts, one of the pts I had the previous night.

This particular pt is something else. First off, she has a hx of IV drug use and was in the ICU d/t a kidney biospy. She was a transfer from the floor. She argued with my preceptor and I most of the night over the "pain management". According to notes from the floor, she will go to the bathroom for about "30 minutes" and then come out with a small bag full of syringes that was not given at the hospital. This pt also has several bruising and needle marks on her lower legs bilaterally that she claims another facility caused by attempting IV starts.

Well, this night I got the pt, I got report from the day nurse who said an order was entered to change her Percocet to 15 mgs PRN q 6 h. He gave her the 15 mg of Percocet at approximately 1600. She was also SCHEDULED for Oxycontin 80 mg at 2100. Well, it was about 2030, and I was getting ready to get her scheduled oxycontin out of the pysis. We have an hour before and after schedule med is due to give the med. I wanted to be somewhat ahead of schedule just in case something happened (ie other pt crashing).

I go to the med room to get the oxycontin. There was another nurse in there at the time. I pulled up my pt's name and her med profile and her oxycontin was grayed out. I asked the other nurse what that meant and she said I would have to go to another pysis to get the oxycontin. I said ok and exited out. As I was on my way to the other pysis, my other patient started crashing. I ran into the room and my preceptor was already there. The other nurse asked me if I wanted her to get the oxycontin for my other patient, I said yes as I'm trying to get oxygen on my crashing patient.

Fastforward to an hour later, I go into my other pt's room and she asked me for her 15 mg of Percocet. I look at the MAR and the nurse who gave her the 80 mg of Oxycontin charted that she also gave her the 15 mg of Percocet AT THE SAME TIME! I advised the patient of this. The pt stated "I never seen that nurse before in my life and she came in her and gave me my 80 mg of Oxycontin, the green pill. She never gave me the 15 mg of Percocet, which are white pills and it would have been 3 of them. She only gave me one pill".

So, I told my preceptor what happened. We checked the pysis and sure enough, the Percocet and Oxycontin were pulled out at the same time under my co-worker's ID. The patient states she knew she couldnt have her Percocet until after 2100, and she would have asked for it. The pt also states the nurse did not have a med cup, she opened the 80 mg of Oxycontin and gave it to her in her hand. My first reaction was to check the trash for open wrappers, but the housekeeping lady had already dumped the trash.

My preceptor went to the other nurse and asked her what happened. It was a totally different story. The other nurse said that she gave all 4 pills to the patient and asked for her pain score which the pt replied it was a 9/10. The preceptor had no choice but to go to the nurse manager because the pt started throwing a fit about the Percocet not being given. The nurse manager interviewed the pt, who told her the same thing she told me.

We had to call the pt's doctor and advise him of what happened, and then override the Percocet and give it to the pt. I gave it and then keep the wrappers for myself. I charted that I gave them and made sure my preceptor was in the room at the time.

I was also interviewed by the nurse manager and I had to send something in writing about this whole incident. So did my preceptor. The nurse involved also had to take a drug test. I don't know who to believe. I feel so bad because it was my patient. What do you all think? I'm only hoping the patient was proven to be a liar. Is that wrong?

[kcochrane]

If I understand this right, this was the same nurse that was helping you figure out why the narc was grayed out. So if she saw your patient crashed while you were trying to get that medication, its seems natural to offer to get it. In my mind pain is a priority - even if someone that is an addict. So I don't find that odd.

But bottom line is that either one could be the addict and either one could be lying. You did what you were supposed to. But please keep us posted. This is a good learning opportunity no matter how it ends up.

[shoegalRN, RN]

Well, I went to work last night and asked my preceptor what happened of that situation and she had no idea. The nurse manager was there, but I didnt want to ask her the outcome, considering it's probably no longer in her hands, and I'm not involved.

We'll see if I see this nurse around the hospital considering she's a float nurse. But I sure have learned a valuable lesson here.

[Ruby Vee, BSN]

hey let me know about the out come of your coworker vs pt c rx hx.also wat did u think bout my comment to ur story:yeah:

you're not texting with your good friends here. please use the english language appropriately for those of us who might want to read what you have to say. it's rather more respectful.

[Ruby Vee, BSN]

drug addicts lie, especially if they believe that lying is going to get them a double dose of narcotics. i find it very difficult to believe that the nurse manager was willing to take the word of an addict seeking drugs over the word of a colleague . . . and the drug test is insulting, especially if the nurse isn't guilty. i cannot imagine her wanting to work with you again!

when your patient is crashing, that patient is your priority, and it was both kind and appropriate of the float nurse to offer to help out. since she was the one who was also helping out at the pyxis station, it's easy to see how she knew that the addict was due for narcotics. assuming that the first thing you'd need help with was the task you were in the middle of when your other patient crashed doesn't sound at all suspicious to me.

if my patient is coding and a colleague wants to help me, that's terrific! but please don't interrupt my cpr to ask if i want you to give pain meds to the patient i was trying to pull pain meds for. just give them already and i'll be eternally grateful! then do my vital signs, i & o and glucose check (we do them hourly). and check to see if there are any other meds due right now. that would be very helpful, and it sounds as if that's what the float nurse was doing.

[Virgo_RN, BSN, RN]

There is no way we can know what really happened. I do not think it odd at all to give 15mg oxycodone along with the scheduled 80mg Oxycontin to someone who has developed such a high tolerance for opiates. I've given people like that handfuls of pills that would kill an elephant, with no adverse effects at all. If I were to take that much narcotic, I'd probably end up in the ICU on a vent. So no, the timing of the meds (giving the PRN at the same time as the scheduled) does not raise any red flags to me. That the nurse specifically offered to medicate your patient doesn't ring any bells either. Helping with med passes when another nurse is slammed is something that I have done for other nurses, and other nurses have done for me.

I think it's very possible that the patient took advantage of the situation in an attempt to get more medication. At the same time, I don't think it's fair to assume the patient is lying simply because of her history.

Tough situation. I hope an investigation gets to the bottom of it.

[kanzi monkey]

i'm all for doing what i can to help my colleagues out, but giving another nurse's narcotics, is the last thing i would want to do.

no way.

as we can plainly see, too much darned liability.

leslie

I think this is interesting. I work in ortho so a huge part of my shift is spent doing pain assessments and giving patients narcotics (often the doses are large, and they are given frequently). I think one of the things nurses on my unit help each other the most with is keeping tabs on how other patients are doing with pain control. We know pain management is a huge priority for our peeps, but obviously it can't outweigh a pt who is having an "ABC" issue. So, when one patient's condition turns southward, the first thing the other nurses on the floor do is ask the primary nurse how her other patients are doing, and whether or not they are due for pain medication any time soon.

I have never had any issues with narcotic discrepancies, and I'm not aware of any other nurse on our floor having issues either. I may have a bucket of frustrations with my co-workers for many things, but trusting that medications will be dispensed, given, and documented appropriately has never been one of them. We're pretty lucky for having this trust. I think our patients benefit a lot from this, since they rarely have to wait to have their pain addressed.

[shoegalRN, RN]

drug addicts lie, especially if they believe that lying is going to get them a double dose of narcotics. i find it very difficult to believe that the nurse manager was willing to take the word of an addict seeking drugs over the word of a colleague . . . and the drug test is insulting, especially if the nurse isn't guilty. i cannot imagine her wanting to work with you again!

when your patient is crashing, that patient is your priority, and it was both kind and appropriate of the float nurse to offer to help out. since she was the one who was also helping out at the pyxis station, it's easy to see how she knew that the addict was due for narcotics. assuming that the first thing you'd need help with was the task you were in the middle of when your other patient crashed doesn't sound at all suspicious to me.

if my patient is coding and a colleague wants to help me, that's terrific! but please don't interrupt my cpr to ask if i want you to give pain meds to the patient i was trying to pull pain meds for. just give them already and i'll be eternally grateful! then do my vital signs, i & o and glucose check (we do them hourly). and check to see if there are any other meds due right now. that would be very helpful, and it sounds as if that's what the float nurse was doing.

i don't know if you are saying you in the general sense or not, but it was not my decision to make this nurse take a drug test. so, if she doesnt want to work with me again, that's fine, but i (as in me personally) didnt suggest to the manager she take a drug test, in fact, i didnt want this to escalate at all, but i knew i had to tell my preceptor because the pt was making a huge deal out of it. i do not like throwing any of my co-workers under the bus, nor do i like being in any of these types of situations, i worked corporate for 14 years and been in siutations regarding co-workers before, but in nursing, it's a whole new ball game.

[meluhn]

There is no way we can know what really happened. I do not think it odd at all to give 15mg oxycodone along with the scheduled 80mg Oxycontin to someone who has developed such a high tolerance for opiates. I've given people like that handfuls of pills that would kill an elephant, with no adverse effects at all. If I were to take that much narcotic, I'd probably end up in the ICU on a vent. So no, the timing of the meds (giving the PRN at the same time as the scheduled) does not raise any red flags to me. That the nurse specifically offered to medicate your patient doesn't ring any bells either. Helping with med passes when another nurse is slammed is something that I have done for other nurses, and other nurses have done for me.

I think it's very possible that the patient took advantage of the situation in an attempt to get more medication. At the same time, I don't think it's fair to assume the patient is lying simply because of her history.

Tough situation. I hope an investigation gets to the bottom of it.

It is not so much the dose or the offering to give the oxy that raises a red flag to me, it is the giving the prn before it was due without being asked to give it. I think that is what the OP is saying.

[shoegalRN, RN]

It is not so much the dose or the offering to give the oxy that raises a red flag to me, it is the giving the prn before it was due without being asked to give it. I think that is what the OP is saying.

That's exactly what I was saying.

I didnt ASK this nurse to give the PRN med. Besides, it wasnt time for it anyway.

I don't know how this all panned out, considering my preceptor dont know the outcome either. I'm just assuming it's being handled and if I see the nurse around the hospital anytime soon, then I'll have my answer.

She's a float nurse, so it may be a while if I see her again.

[Virgo_RN, BSN, RN]

It is not so much the dose or the offering to give the oxy that raises a red flag to me, it is the giving the prn before it was due without being asked to give it. I think that is what the OP is saying.

Other posters mentioned it. I was replying to those concerns.