Morphine Authorization

Nurses Safety

Published

I'm new here and not sure if this is posted in the right area. I've always loved coming to this site as a lurker but decided to join :) The other night I was working (NOCS) and had a pt. who was given an order for Morphine on PMs. The ADON and the PM nurse before me took the Morphine out of narcotics and administered it without authorization from pharmacy, although they did have the MD order. The PM nurse reported to me that pharmacy was going to be calling and giving authorization. Well...pharmacy called at 11 pm while the PM nurse was still there and refused authorization. When the pt's family asked why I didn't give the morphine later that night, I simply stated that I didn't have authorization right now but I could give something else if needed (he was comfortable and slept all night). I called my boss in the morning and I was the one who got scolded. She said I should have followed up with pharmacy asking why they didn't authorize it, etc. My question is, was I legally correct not to give the morphine? Also, why would I call pharmacy for NOCS when they had just called the facility at 11pm to deny authorization? Thanks for any input!

I agree. That's why there's always these issues. I haven't worked in hospitals before but I think pharmacy has more control/say in LTC. I'm all alone on NOCS for over 50 pts. so I try my best. It just sucks when my boss/management thinks that I'm doing a crappy job.

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Specializes in Surgery, Tele, OB, Peds,ED-True Float RN.
My understanding was that the pharmacist on-call wasn't at his facility as it was after hours and had no access to the MD order to verify anything so he denied authorization. And that's what contingency is for-if we don't have the meds delivered. However, for narcotics we still need pharmacy to approve us going in and pulling the med out.

Thanks for your explanation, I understand what you are talking about now! Still weird to me tho'... like GM2RN said, if a Nurse with a brain, a license and assessment skills AND a Doc with a brain and a medical license can't figure it out then there's something wrong... who is a Pharmacist to refuse it? I agree GM2RN, stupid...

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I agree. That's why there's always these issues. I haven't worked in hospitals before but I think pharmacy has more control/say in LTC. I'm all alone on NOCS for over 50 pts. so I try my best. It just sucks when my boss/management thinks that I'm doing a crappy job.

Yeah, well, you have to play by their rules but you don't have to let them get into your head. You know what's what so just let it roll off your back. I'm sure you have better things to do than spend your time thinking about some idiots in suits. :up:

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We have to have authorization from pharmacy where I work as well which is a LTC facility for our narcs. And the only reason we wouldn't get it would be if there is something wrong with the signed script from the doctor which is what they need in order to send the auth. number. Sometimes the MD leaves out how often to give or doesn't put on how many pills to be filled and so forth. And no matter what time of night it is we have an emergency line to page the on-call pharmacist. So we can get what we need at any time.

If we pulled without the auth. number where I work we would be in trouble.

So I'm curious about the pharmacist not being in his facility to see the order so he denied it? What if you needed to give the medicine? Give it before they authorized you to do so? I mean if you follow policy and wait for the number but have no pharmacist available isn't this delay in care? I think some of the hoops we have to jump through are ridiculous. I work on our rehab. side of the building so we get admissions all the time who are post surgery and so forth so we are always getting auth. numbers. And it can be time consuming.

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I learned recently at a nursing meeting that nursing homes are more regulated than nuclear power plants! I believe it is for that reason that these asinine scenarios occur. In sub-acute(non-hospital), we have an narcotic box for emergency situations, and with frequent admissions, "emergency" becomes a daily occurrence.

I have had times when the pharmacy would not finish processing the admission order because there was not a date on the script. OK, I'll date it, could you please send my patient's meds? Also, I have been told that I could not pull the narc from the e-kit because the delivery was "on its way." "On its way" could, I am not kidding, mean five hours later! Meanwhile, I have a patient in front of me crying in pain. It is at that point that I call the doctor and have him call in to pharmacy another 2 or 3 pills until the drugs arrive. The problem is that they are held accountable to the federal government for EVERY SINGLE PILL. Abuse of narcotics by health care professionals has led to this increased regulation. Has it fixed the problem? Um, no. Anyway, just my:twocents:.

From the DEA, Office of Diversion Control's website:

"Many of the narcotics, depressants, and stimulants manufactured for legitimate medical use are subject to abuse and have, therefore, been brought under legal control. Under federal law, all businesses that import, export, manufacture, or distribute controlled substances; all health professionals licensed to dispense, administer, or prescribe them; and all pharmacies authorized to fill prescriptions must register with the DEA. Registrants must comply with regulatory requirements relating to drug security and recordkeeping. The DEA is also obligated under international treaties to monitor the movement of licit controlled substances across U.S. borders and to issue import and export permits for that movement.

Diversion investigations involve, but are not limited to, physicians who sell prescriptions to drug dealers or abusers; pharmacists who falsify records and subsequently sell the drugs; employees who steal from inventory and falsify orders to cover illicit sales; prescription forgers; and individuals who commit armed robbery of pharmacies and drug distributors."

ETA: You did nothing wrong. I would have acted in the same manner. The patient was in bed, and he was resting comfortably. Unless this was a scheduled med to be given, then I would have followed up further.

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Specializes in ortho, hospice volunteer, psych,.

sounds as though you happened to be in the wrong place at the wrong time. you did nothing at all wrong. hang in there, because when your manager calms down a little bit, she'll realize you didn't

make an error.

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Specializes in MDS RNAC, LTC, Psych, LTAC.
Ok, but I still don't get why authorization from the pharmacy to give a medication is even necessary, AT ALL, let alone in a situation like this. It's like pharmacy can override the doctor's order to give the med. Who cares that the pharmacy hasn't sent it? If you have a valid order and you have access to it, that should be good enough. I realize that LTC plays by their own set of rules, but this one is just plain stupid, IMO.

Edited to add: OP, I just read your last post. I appreciate you trying to explain it, but I still don't see the rationale behind it. Like I said, it's a stupid rule.

GM2RN, If you will read my prior post in this posting you will see why. I spoke at length about what is going on in my state. I agree it is a stupid rule and its something pharmacy in my state in some LTC corporations let pharmacy handle and I sure don't understand why the pharmacist in question would do that but pharmacy in LTC on the West Coast anyway is getting way too much power over physicians and nurses. I blame LTC corpoatations myself. :devil:

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Specializes in MDS RNAC, LTC, Psych, LTAC.
I learned recently at a nursing meeting that nursing homes are more regulated than nuclear power plants! I believe it is for that reason that these asinine scenarios occur. In sub-acute(non-hospital), we have an narcotic box for emergency situations, and with frequent admissions, "emergency" becomes a daily occurrence.

I have had times when the pharmacy would not finish processing the admission order because there was not a date on the script. OK, I'll date it, could you please send my patient's meds? Also, I have been told that I could not pull the narc from the e-kit because the delivery was "on its way." "On its way" could, I am not kidding, mean five hours later! Meanwhile, I have a patient in front of me crying in pain. It is at that point that I call the doctor and have him call in to pharmacy another 2 or 3 pills until the drugs arrive. The problem is that they are held accountable to the federal government for EVERY SINGLE PILL. Abuse of narcotics by health care professionals has led to this increased regulation. Has it fixed the problem? Um, no. Anyway, just my:twocents:.

From the DEA, Office of Diversion Control's website:

"Many of the narcotics, depressants, and stimulants manufactured for legitimate medical use are subject to abuse and have, therefore, been brought under legal control. Under federal law, all businesses that import, export, manufacture, or distribute controlled substances; all health professionals licensed to dispense, administer, or prescribe them; and all pharmacies authorized to fill prescriptions must register with the DEA. Registrants must comply with regulatory requirements relating to drug security and recordkeeping. The DEA is also obligated under international treaties to monitor the movement of licit controlled substances across U.S. borders and to issue import and export permits for that movement.

Diversion investigations involve, but are not limited to, physicians who sell prescriptions to drug dealers or abusers; pharmacists who falsify records and subsequently sell the drugs; employees who steal from inventory and falsify orders to cover illicit sales; prescription forgers; and individuals who commit armed robbery of pharmacies and drug distributors."

ETA: You did nothing wrong. I would have acted in the same manner. The patient was in bed, and he was resting comfortably. Unless this was a scheduled med to be given, then I would have followed up further.

Thank you. Well now I know why they do it then get your nurses in LTC a DEA number. I have no problem with it if it will make me able to give medications to a patient in pain. Thank you and yes LTC is more regulated than nuclear power plants. You said it much more eloquently than I can or could.

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GM2RN, If you will read my prior post in this posting you will see why. I spoke at length about what is going on in my state. I agree it is a stupid rule and its something pharmacy in my state in some LTC corporations let pharmacy handle and I sure don't understand why the pharmacist in question would do that but pharmacy in LTC on the West Coast anyway is getting way too much power over physicians and nurses. I blame LTC corpoatations myself. :devil:

I've read the answers and get what is being said about the process and why it's done, so maybe the word "why" isn't really what I mean. I'm looking for something deeper. What I don't understand is how this process prevents diversion, misuse, mistakes, or any of the other things that the stated intention is supposed to do. It seems to me that it's not patient focused at all, and the only thing it does is get in the way of caring for patients.

That said, I don't think the answer I'm looking for exists. I think the best I'm gonna get is what has already been offered.

Thanks.

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Thanks for all of your input. I definitely get frustrated with pharmacy in the LTC setting. They seem to revel in the fact that they can approve/deny giving patients the medicine they need (although maybe just our pharmacy haha). Hope you all have a great Independence Day weekend!!

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Specializes in MDS RNAC, LTC, Psych, LTAC.
I've read the answers and get what is being said about the process and why it's done, so maybe the word "why" isn't really what I mean. I'm looking for something deeper. What I don't understand is how this process prevents diversion, misuse, mistakes, or any of the other things that the stated intention is supposed to do. It seems to me that it's not patient focused at all, and the only thing it does is get in the way of caring for patients.

That said, I don't think the answer I'm looking for exists. I think the best I'm gonna get is what has already been offered.

Thanks.

GM2RN,

I agree it does none of those things and makes a nurse's job in LTC even harder. I get angry about it and ask co-workers and they say its because of diversion and don't question it and that perhaps why nurses in LTC are treated poorly in general. Out here in PacNW its just the facilities that are ran by huge out of state corporations. Maybe that has something to do with it and I love LTC and the patients and I will miss all I have ever taken care of but I have never been so disrespected as a person and an RN working LTC by management. It has about broke my spirit and made me question why I am a nurse. That issue there and among others in the field. I know I am not the only nurse because the same facilities here need nurses all the time. Its a tight job market and if they were treated nurses well they would stay. Thank you for your thoughts and I am glad the OP brought it up. It bothers me so much and who in the end it hurts is the resident in pain.

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GM2RN,

I agree it does none of those things and makes a nurse's job in LTC even harder. I get angry about it and ask co-workers and they say its because of diversion and don't question it and that perhaps why nurses in LTC are treated poorly in general. Out here in PacNW its just the facilities that are ran by huge out of state corporations. Maybe that has something to do with it and I love LTC and the patients and I will miss all I have ever taken care of but I have never been so disrespected as a person and an RN working LTC by management. It has about broke my spirit and made me question why I am a nurse. That issue there and among others in the field. I know I am not the only nurse because the same facilities here need nurses all the time. Its a tight job market and if they were treated nurses well they would stay. Thank you for your thoughts and I am glad the OP brought it up. It bothers me so much and who in the end it hurts is the resident in pain.

There are bad work environments for nurses everywhere, but from reading the threads on this BB it seems that those problems and the number of those toxic environments are multiplied many fold in LTC. And if the work environment is bad for the nurses, the patients necessarily have to suffer for it.

It is very disheartening to hear that so many good nurses have to leave LTC for the reasons you stated, and that patients needlessly suffer because of the demands that are put on the ones who stay.

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