Made a huge mistake now worried for career.

Specialties Geriatric

Published

I'm a new RN and have only worked in LTC for a few months. A situation happened where a resident requested a PRN drug and it was unavailable. We have been instructed not to be afraid to use our edk's and get what we need. I have never had to pulled anything from the Narc box before and was told by different ppl we had a new policy. So in short the policy was misunderstood and I didn't get prior authorization from pharmacy to pull the drug. The resident did however have an order and the pharmacy had a copy of a hard script and got the pills out later that night. I pulled the med and gave them when they were requested. My problem is I didn't get authorization for pharm and now I am concern for my job and license. The adon when I notified him stated this wasn't a med error but a very big problem and would take care of today. I didn't get a response back today everyone was unavailable or in meetings. I dont know all the rules and regulations but really am in constant worry over well my career now. I cant seem to get an answer or call back to know how this is going to be handled.

Has anyone had any similar situations or offer any input.

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If they haven't told you to stay home, there is probably little to worry about. If the patient had an order for the med then he was supposed to get it. Seems there are issues with turnaround time from receiving orders and actually getting them from the pharmacy. Are you on nights? Is there a pharmacist available 24/7?

Maybe there just needs to be a review of the 'new' policy.

Best wishes!

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There was a pharmacist available who put a stat on the order but that usually takes about 4 hours or so. I am on nights, I was just unaware of the getting the approval code from the pharmacy and did not do so. The ADON told me that was against the law and a big no no. I am not sure if he was trying to scare me or if it really it a big problem. I'm off for several days so I feel like I will be in turmoil till I can get an answer from them.

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If it was a controlled substance then yea, I can see the big no no here. I don't think you need to worry about losing your license though. I have seen disciplinary actions for much worse and the persons were able to keep their license and keep practicing. I honestly can't tell you as far a your job is concerned. I don't want to give false reassurances but at the same time I can see that in the end it was an honest mistake and I am sure your supervisor does too. I don't know if the DEA does compliance checks at your hospital pharmacy, but more than likely that is where the concern lies and why they had the new policy. I used to work for a pharmaceutical wholesaler and the DEA is constantly working to suppress diversion of controls, especially C2s. You weren't diverting it if it was ordered for the patient and you gave it to the patient, but it I guess without pharmacist approval they are just concerned about the potential diversion.

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There is a difference between a law and a policy. Although every state is different, it seems that the facility must assure that you were given the appropriate information during your orientation.

Talk to the person who set up your orientation, and ask for a copy of the policy. And try to keep yourself contained until you have a better idea of what is happening.

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Specializes in LTC, Memory loss, PDN.

Maybe I'm missing something, but the resident's needs were met in a timely manner - that's good nursing. I can see where the facility may be concerned about charging the Rx to the resident, but can someone explain to me why the approval is needed and why it is against the law, because right now I don't see what the big deal is. Anyhow, if it is indeed such a big deal, then why isn't there a note in bold print on or in the emergency drug box to alert staff. Again, I just don't get it. If, as a nurse manager, you have a policy that is crucial to operations, you make darn sure everyone is informed about it, not once, but two and three times, because lord forbid nursing staff should turn human and actually forget something.

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I've never ever heard of having to call the pharmacy first for approval before taking a med out of the emergency box. :confused: I've been in nursing for 37 years.

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Specializes in ER, ICU.

Did they train you for this? If this wasn't covered in writing during your orientation you can't be expected to know all policies for all situations by ESP. Without anger, just explain that you made the best decision you could in good faith and if they are going to berate you for not doing things the "right" way, they must train you properly.

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The med was withdrew from the narcotic ekit. Getting updated or policies is almost impossible everything is out of date and nights your lucky to be notified of new changes until the DON asks why you didn't do something. Usually the I didn't know doesn't fly maybe LTC isn't for me.

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I've never ever heard of having to call the pharmacy first for approval before taking a med out of the emergency box. :confused: I've been in nursing for 37 years.

Agreed. Isn't that the purpose of an emergency box in the first place?

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This is a LTC thing, alledgedly has been on the books for a "long" time but never enforced....still dont see it enforced .....maybe this particular LTC was dinged for it?...to me, it is inserting the pharmacist between the nurse and the doc...but, no one asked me!

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Specializes in Developmental Disabilites,.

I don't see the big deal here. Why would you even call the pharm? To prevent diversion? Dosen't the floor staff count narcs and sign them out against residents. You had an md order and you gave the right drug. I just don't understand the problem.

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