Missing Narcs - my responsibilities

Nurses Medications

Published

I lost my first attempt to post this so sorry if this seems choppy.

Last Wednesday , new nurse to our facility (but not a new nurse) wound up having a bubble narc card with at least 24 pills go missing under suspicious circumstances. The nurse coming on shift has been there over a year caught the issue and reported to management. Search of cart done with no recovery of missing narcs. Suspicious circumstances include asking established nurse to help "fix" issue, fingerpointing, finding one of the missing record sheets folded multiple times in the trash (found by new nurse herself), disappearing to bathroom with purse for extended extended period of time. This was all done on day I was off and hearing this after the fact.

Next day to everyone's surprise new nurse at work and no one being required to drug test.

The next shift, she called off.

Yesterday, less than a week later, I was surprised to be taking over same said cart from her with the atmosphere of "business as usual" attitude. I was more anal than usual and found a couple of cards misplaced, one bubble pack had a higher number than recorded, and another had a lower count than recorded.

THE KICKER. After taking over cart, I started to pull narcs on patient that had been discharged earlier that day. I noticed that he used more PRN pain pills than usual and upon closer look saw that 2 of 4 recorded for her shift had been administered at least 3 1/2 hours AFTER patient discharge at 1035. Her shift started at 0600. I immediately told management and expressed concern about apparent lack of action to date.

Of course stated couldn't share info on investigation.

Questions:

Live in Arizona. Does facility have to report to state board, police or okay to keep in house?

Do I now have responsibility to report elsewhere now that I have direct knowledge of times of administration not matching up with patient actually still being a patient?

Thank you. Any direction/resources/information will be greatly appreciated. And remember to get in one more good hike before summer hits!

Specializes in Critical Care, Education.

If you have not gotten satisfactory response from your supervisor, I would suggest that you go up the chain of command. This process should be outlined in your organization's P&Ps. There are two other mechanisms that are outside the control of the nursing division - if you are concerned about the incident being 'buried'.

You can fill out and submit an incident report. These are handled by Risk Management - and they are pit bulls when it comes to following up. You could also use your organization's compliance line -- usually a 1-800 number that is managed by a 3rd party. ALL of these calls/issues are reported 'up' directly to someone in the (executive) C-Suite that is the designated Compliance Officer. Don't try to make the call anonymously because it will not be credible.

Be prepared for splash-back. As a whistleblower, you will undoubtedly be immune from retaliation IF your report is made in 'good faith' but that doesn't mean that you can't be made miserable at work - given crappy assignments, work scrutinized, etc.

I am proud of you as a fellow nurse. My personal definition of courage is doing the (hard) right thing when it would be easier just to turn a blind eye.

Muser69

176 Posts

Specializes in Critical care.

Nurse in our ER notified the board of a nurse who was abusing drugs . The reporting nurse ( who was the facility's nurse of the year) was fired. The union successfully sued and the fired nurse got a ton of money in a settlement. I would stay out of it and make sure your supervisor takes responsibility.

elkpark

14,633 Posts

I would definitely submit an occurrence report, if only to cover my own butt ...

HikingGalRN

3 Posts

We are a smaller facility where 3 nurses work each shift with minimal layers of organization. Usually all is good to go except recently when had turnover due to lack of more help and raises. Now census low, overworked existing nurses, and no active DON for 2 months has all pulled in different stressed directions.

What is an occurrence report and what issue am I reporting except the noticing of time/patient mismatch? Anyone looking at sheets and narcs, now in management hands, can see the discrepancy. I just don't her to start finger pointing at me since I followed her and also want other nurses to be aware to be extra cautious when working with narcs.

Specializes in HH, Peds, Rehab, Clinical.

Are narcs not being counted at the beginning and end of each shift with two nurses doing the count? I just can't fathom how entire cards of meds go missing if they are being accounted for 2-3 times per day.

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I think you should contact your and ask them. If you don't have malpractice insurance get some immediately....every nurse should have it.

Second I would check with your BON rules and regs. I believe Arizona has a mandatory reporting for license holders or you can be considered culpable.

Anyone can submit a complaint; however, the law mandates certain individuals and institutions report information to the Board. Pursuant to icon_pdf_02.gif 32-1664 (B):

A licensee, a certificate holder, and a health care institution as defined in 36-401 shall, and any other person may, report to the board any information the licensee, certificate holder, health care institution or individual may have that appears to show that a licensee or certificate holder is, was or may be a threat to the public health or safety.”

ARS 32-1601(18) (k) defines unprofessional conduct, in part, as “failing to report to the board any evidence that a professional or practical nurse or nursing assistant is or may be:

(i) Incompetent

(ii) Guilty of unprofessional conduct

(iii) Mentally or physically unable to safely practice nursing or perform nursing related duties”

2. What is mandatory reporting & what conduct should be reported?

Mandatory reporting assists the Board in protecting the public through the discovery of unsafe or substandard nursing practice or conduct. The law does not require, and the Board does not intend, every minor nursing error be reported.

Conduct or practice that should be reported:

  • Information that a nurse or certificate holder may be mentally or physically unable to safely practice nursing or perform nursing related duties
  • Conduct involving practicing beyond the scope of practice of the license or certificate. Examples include knowingly giving a medication not authorized by a treating provider, obtaining laboratory or other tests not authorized by a treating provider, unauthorized adjusting of dosage
  • Conduct which leads to the dismissal for unsafe nursing practice or conduct or other unprofessional conduct
  • Conduct that appears to be a contributing factor to high risk/harm to a patient and required medical intervention
  • Conduct that appears to be a contributing factor to the death of a patient
  • Conduct involving the misuse of alcohol or other chemical substances to the extent that nursing practice may be impaired or may be detrimentally impacted

  • Actual or suspected drug diversion

  • Pattern of failure to account for medications; failing to account for wastage of control drugs
  • Falsification of medical or treatment records
  • Pattern of inappropriate judgment or nursing skill
  • Failing to assess or intervene in behalf of patient(s)
  • Conduct involving sexual contact with a patient, patient family member or other dual relationships
  • Conduct involving physical/verbal patient abuse
  • Conduct involving misappropriation, theft or exploitation of a patient
  • Practicing nursing without a valid nursing license
  • Violation of a disciplinary sanction imposed on the nurse’s license by the board
  • Conduct that deceives, defrauds or harms the public

In addition to the mandatory reporting, individual licensees are required to report the following:

  • Criminal charges, felony and misdemeanor, which may affect public safety within ten days from when the charge(s) are filed
  • Felony conviction(s) must be reported within ten days of the conviction

Arizona State Board of Nursing | Discipline FAQs

Specializes in orthopedic/trauma, Informatics, diabetes.

That is the one thing that I hated the most about working in a LTC/med cart. I came in as new nurse and found some discrepencies-nothing near what you described. I made very good friends with QA nurse and always reported to charge nurse then the QA nurse. I am extremely anal about narcs.

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