Nurse giving discontinue medications to other patients

Nurses Medications

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Hello all,

I work as Director (RN) in a small unit ( assisted Living)of about 21 residents. A female patient was admitted yesterday to my unit. I made sure that all her meds were coming as the patient has some psych issues, confusion... However, one of my nurses got there this morning, got a report that patient only slept 2 hours all night. Patient has order for Haldol and ativan prn. Nurse said that she could not find patient haldol, so she went to med room were we keep overflows and d/c meds and she found d/c haldol of a former resident and gave it to the new patient!!(scary). I know this is unacceptable, however what is the policy of the nurse practice act for such issue? There was no harm cause. Can the nurse be fired for this? please help

Specializes in Critical Care.
Even in Acute care...if the med is in the original bubble pack and the right dose it is a common practice. But I see your point is that dispensing.

Hummmm...I am interested to others response.

It would be more complex if there was "dispensing" involved, but from the description there is no dispensing of medication involved, only administration or assisting with self administration. When a Nurse administers or assists with self-administration they are using a drug that has already been dispensed (measured, labelled, packaged) and is not re-dispensing the drug.

This facility does not have an e-kit. It is a private paid, no medicare/medicaid. Why would you wait for a resident to be down to his/her last pill.

I have worked in SNF and we had that. However ALF does have that and again it is a private pay, no medicare/medicaid

Specializes in Critical Care.

I'm not totally clear what the private pay vs medicare matters.

Whether or not you have e-kits isn't really the issue, an e-kit is just one of many ways of having a plan for how to deal with these situations, so if your facility's plan doesn't include the use of an e-kit, then what is the plan.

From your description it sounds like Nursing staff was administering these medications, though it is a little different if they were actually assisting with self-administration, maybe you could clarify.

They didn't, though. The first nurse put the meds in the wrong place.

Which is a foreseeable problem and the facility should have a planned solution. Such as an e-kit.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
It would be more complex if there was "dispensing" involved, but from the description there is no dispensing of medication involved, only administration or assisting with self administration. When a Nurse administers or assists with self-administration they are using a drug that has already been dispensed (measured, labelled, packaged) and is not re-dispensing the drug.
It doesn't sound like it was bubble packed and they took it from another patients prescription bottle. Bubble pack is one thing another patients bottle I am not sure.

Either way I don't think it's a disciplined offense it is a teaching moment and an indication the OP needs to develop policy.

Specializes in Gerontology, Med surg, Home Health.

Perhaps in Massachusetts the regs are stricter. That would be considered dispensing without a license. Pure and simple you can not borrow meds from one resident to give to another. Those days are long gone. Years ago, we used to save the discontinued antibiotics and other non-narcotics and give them to the nurse practitioner who would take them to the homeless shelter. Now, we'd end up with a significant fine if not worse.

I don't think the BON would call it diversion. They usually only use that term when dealing with narcotics. It's bad practice. From what you said, the nurse's intentions were good. I'd have a serious talk with the director of the PHARMACY and find out why that patient's medications weren't delivered in a timely manner. If this is an ongoing problem, you should consider getting an E-Kit that contains the most common medications your residents use so if they aren't available, the nurse has an appropriate option.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Perhaps in Massachusetts the regs are stricter. That would be considered dispensing without a license. Pure and simple you can not borrow meds from one resident to give to another. Those days are long gone. Years ago, we used to save the discontinued antibiotics and other non-narcotics and give them to the nurse practitioner who would take them to the homeless shelter. Now, we'd end up with a significant fine if not worse.

I don't think the BON would call it diversion. They usually only use that term when dealing with narcotics. It's bad practice. From what you said, the nurse's intentions were good. I'd have a serious talk with the director of the PHARMACY and find out why that patient's medications weren't delivered in a timely manner. If this is an ongoing problem, you should consider getting an E-Kit that contains the most common medications your residents use so if they aren't available, the nurse has an appropriate option.

That is what I thought....I've been waiting for you to weigh in. I worked an LTAC for a while as perdiem supervisor on the north shore....we had an extensive "med closet"/e-kit and 16 hours of pharmacy... but I am not familiar with LTC

In the State of Colorado (or at least the State of My Facility :)), it is considered diversion and insurance fraud. Does it happen? Yes, but on the other hand, that is why we have an E-Kit.

Specializes in ICU.

Seems pretty ridiculous to me to call it dispensing without a license, diversion, or insurance fraud...the other pt didn't need the meds (they were d/c'ed), and the nurse's pt did...guess they should have just gone without!

Specializes in ICU.

This is where "critical thinking" (aka common sense) and problem-solving go out the window...

Specializes in Leadership, Psych, HomeCare, Amb. Care.
Seems pretty ridiculous to me to call it dispensing without a license, diversion, or insurance fraud...the other pt didn't need the meds (they were d/c'ed), and the nurse's pt did...guess they should have just gone without!

CMS & TJC have a number of rules designed to protect the patient, but appear counter intuitive in certain situations. Borrowing is frowned upon, so it is up to the facility to develop a process and policy that accounts for these situations.

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