Honesty IS The Best Policy.

  1. I have such a highly developed guilt complex, that I can't lie about things - must have been something my mother beat into me or something. A department head I worked for once told me that I could be almost 'painfully honest', altho I didn't think it was meant as a compliment.

    But I still think if you just practice it, life is much simpler overall.

    Last weekend, I gave one of my ladies her usual early AM Xanax. We use the bubble pac system, and for some reason, this facility does not lock up Xanax.

    The card for early AM has a bright pink sticker on it - and it was there on Saturday morning.
    On Sunday nite when I came in, we were short a CNA, so I decided to start organizing my stuff for morning early, in case I had to help - I'm glad I did. When I went to look for that lady's Xanax card, it was gone - thinking I had just misfiled it the day before, I looked in the slot behind it - not there.

    I ended up going thru that whole med cart - several times - and it was just gone! When the MDS coordinator came in at 4AM, she flipped thru and couldn't find it.

    I'd never had anything like this happen so I went back and asked the other nurse what to do - she told me not to say anything, and just to re-order it.

    Hello! I don't care whether they lock it up or not - it's still a controlled substance. I wrote a note to the DON telling her what happened, and what I did, and stuck it on her door, then took a dose from her noon card, and left a note in the MAR. I also reported it to the day nurse, thinking she'd come across it somehow.

    Well, she didn't - and from what I heard the DON called all the other nurses and subtley accused them of taking it!

    The thing is - when you make a mistake or find something like that, I've always felt the worst thing to do is to try to cover it up, altho I've seen people do it.
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  2. 14 Comments

  3. by   Cherish
    I wouldn't have covered anything up. When you do something like that it always comes back to bite you in the bum. I am not an RN so can't tell you if what you did is right or wrong, but ethically I think you did the right thing.
  4. by   dekatn
    I can't imagine a narcotic drug like xanax not locked, wouldn't you have to do a narc count on it just like all other narcs? Do you have to sign it out like other narcs? You did the right thing, but I would check into why this medication isn't locked and counted along with other narcs.
  5. by   ginger58
    Xanax isn't a narcotic.

    Schedule IV Narcotics or non-narcotics
    (a) The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule III.
    (b) The drug or other substance has a currently accepted medical use in treatment in the United States.
    (c) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in Schedule III.
    Last edit by ginger58 on Mar 30, '07 : Reason: added info about Schedule IV
  6. by   dekatn
    oops, Ginger58, you are right. We keep xanax, diazepam, lorazepam locked with narcs and other drugs that have a high potential for abuse.
  7. by   gonzo1
    you absolutely did the right thing notifying charge about these missing meds. An incident report or what ever paper work your facility requires should be done too. Xanax is a med that should be under lock and key and has potential for abuse. Hope it doesn't go missing again.
    I have found that honesty is always the best policy
  8. by   banditrn
    I've never gotten a satisfactory answer why they don't lock the Xanax up at this facility - the card has the big red C indicating it's a controlled substance - and it was locked up at the other facility where I worked.

    And, I believe it was always a lock-up drug at the hospital. I THINK their rationale is that it's in a locked med cart.

    The thing is that I don't know if when the gals take the cart out with them on days and evenings if they lock the cart when they leave it. BUT the way those cards are stuffed in there, a person would almost have to know it was there - it would be too hard to just by chance remove the one card with Xanax on it, quickly, before anyone noticed.
  9. by   Daytonite
    our personal ethics sometimes play a number in our minds when something like this happens when you find problems with drugs. you did the right thing to report the missing card of xanax. the don was also right in starting an investigation to determine what might have happened to it. it's not your fault if the don can't be discrete and tactful in her methods of questioning.

    i've seen nurses who are very nonchalant about not locking up their medication carts when leaving them standing in the halls. that can make them easy targets for anyone who has larceny on their mind. patient safety is also at issue. we had a patient in one facility who was able to get into the back section of a medication cart which one nurse consistently left unlocked because she had difficulty figuring out which key opened it. the oversized bottles of medications were stored back there. the patient, bent on committing suicide, opened the unattended cart, took the largest bottle of pills she could find, went back to her room and proceeded to take every pill in the bottle. when nothing happened after a few hours, she reported what she had done to the nursing assistants who told the don. the patient was sent to the er for evaluation, a big incident report done and the nurse was fired since she had been warned about keeping her cart locked when leaving it in the hallways before.

    something that i didn't see anyone else mention is that when these missing drugs have to be replaced, whoever is paying for them (the patient or their insurance coverage) ultimately ends up buying the replacement drugs. that's not fair. if someone did steal the card of xanax then they stole from the patient. they will realize that their theft was noticed immediately and, hopefully, won't be too quick to do that again. it's quite possible, i suppose, that the card will turn up as having gotten caught and trapped somewhere between the drawer and the inside of the cart itself. i've seen that happen before, too.
  10. by   ktwlpn
    Quote from banditrn
    I've never gotten a satisfactory answer why they don't lock the Xanax up at this facility - the card has the big red C indicating it's a controlled substance - and it was locked up at the other facility where I worked.

    And, I believe it was always a lock-up drug at the hospital. I THINK their rationale is that it's in a locked med cart.

    The thing is that I don't know if when the gals take the cart out with them on days and evenings if they lock the cart when they leave it. BUT the way those cards are stuffed in there, a person would almost have to know it was there - it would be too hard to just by chance remove the one card with Xanax on it, quickly, before anyone noticed.
    It's only been in the last 3 or 4 years that we started locking and counting those drugs.I was glad when we started doing it because too much stuff was going missing and the system protects us...A resident died and no-one documented disposing of her meds-2 nurses were diverting and both lost their jobs.It never would have happened if we were securing the meds properly....
  11. by   CapeCodMermaid
    We've always locked up Xanax in Massachusetts. Two facilities I worked at had us locking up Ultram because of the high incidence of abuse. I can't tell a lie, either. Fess up and take the consequences. The nurses used to make fun of the way I did narcotic count. Imagine, I actually paid attention and looked at both the book and the card. Lots of them hardly looked at all and then wondered why count was off 8 hours later. If you've ever been in a building where the feds walked in because of suspicion of drug diversion, you would never have such a nonchalant attitude towards locked up meds.
  12. by   banditrn
    Quote from CapeCodMermaid
    We've always locked up Xanax in Massachusetts. Two facilities I worked at had us locking up Ultram because of the high incidence of abuse. I can't tell a lie, either. Fess up and take the consequences. The nurses used to make fun of the way I did narcotic count. Imagine, I actually paid attention and looked at both the book and the card. Lots of them hardly looked at all and then wondered why count was off 8 hours later. If you've ever been in a building where the feds walked in because of suspicion of drug diversion, you would never have such a nonchalant attitude towards locked up meds.
    Capecod - I came from working in the hospital, where just ONE missing pill could be cause for 2 hours of headache until it was accounted for - and they wonder why I get hysterical.

    In the last LTC facility - the one where I quit, if a narc was missing, they'd just leave a blank line in the narc book. This male nurse and I almost had a throw down over that policy, when I found out it was him that wasn't charting his narcs - he called me a 'damned uptight ICU nurse'! I just reported his hiney to the DON and told her I thought they needed to be a little more responsible.
  13. by   SuesquatchRN
    I sure would have reported that card. NYS is very strict, and suspicion of diversion is one cloud I don't need over my head.

    Only our DON orders controlled substances, except for refills.
  14. by   Spidey's mom
    Xanax is locked up with the narcs where I work.

    Always tell the truth.

    steph

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