I am new to home health, and I just started working as a case manager at a very small agency that does mostly non-skilled patients (only about 10% skilled) and ALL their patients are Medicaid. It is a family business and most of our clients are friends of the family that owns the company. Let's just say it is a very "urban" population.
Here's my situation: I am a nurse in recovery and I am a part of my state's monitoring program, so I am paranoid about narcotic issues. We have several patients where it is obvious to me that they are selling their narcotics. If they ever get caught, I would be liable in any way as an accomplice or something? My DON says that with non-skilled patients, we aren't responsible for their meds since we don't set them up and such. However, we still do medication reconciliation with the recertification visits. I do my medication reconciliation by looking at all the bottles and comparing them with our records in addition to asking the patient (because the patient doesn't always remember what has happened in two months). The other nurses just ask the patient. Using my method, I have discovered missing bottles of narcotics and bottles that were empty long before they should have been, and I don't think the patients aren't overdosing on them... they are selling them. One of our skilled patients let a drug deal go down right in front of me and I was allowed to discharge that patient, but I was chastised for informing the prescribing physician that there were narcotics missing from another non-skilled patient's home. If we start tattling on all our patients that do this, we would probably lose a lot of business, so I understand the hesitancy in being too harsh.... but I am just trying to CMA if you know what I mean!
What, in your opinion, is my responsibility as the nurse doing the recertification and assessment? Would you report that meds were found missing for a non-skilled patient?