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.

CMS certainly discourages borrowing meds as a routine way of dealing with larger medication availability issues, and does state it should only be done when not receiving a medication could have a noticeable effect on a patient; you shouldn't borrow another patient's lipitor, but a patient with a psych diagnosis where a need for haldol has been assessed is much different.

CMS and BON's have taken action when "borrowing" is not properly documented, but I can't find anything to suggest that by itself it is fraud, maybe someone could post a link to something that says this? Whether "borrowing" or not, you can't falsify billing, but so long as it's properly documented then there is no fraud in the billing.

First, in LTC, we return unused drugs for Medicaid reimbursement. If you borrow from a patient, then you are, in a sense, stealing because that drug will no longer be available for reimbursement.

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/LewinGroup.pdf

Second, in the State of Colorado, borrowing is defined as a diversion, and is a punishable offense.

"Staff gives patient “A” medication which belongs to patient “B”, because the medication for patient “A” is not available. Is this reportable? Yes, it is reportable. It was deliberate, and a diversion."

http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheadername1=Content-Disposition&blobheadername2=Content-Type&blobheadervalue1=inline%3B+filename%3D%22Occurrence+Reporting+Manual.pdf%22&blobheadervalue2=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251841695540&ssbinary=true this is on page 25.

Sorry, I'm on the iPad, and not as adept at putting in links on the thing as I am on my laptop.

Specializes in Critical Care.
First, in LTC, we return unused drugs for Medicaid reimbursement. If you borrow from a patient, then you are, in a sense, stealing because that drug will no longer be available for reimbursement.

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/LewinGroup.pdf

If not properly documented, then yes, you could be stealing from a patient, so long as the any loss of reimbursement to the discharged patient is covered by documentation, then there is no stealing. And that assumes that the situation here is "self-administration", where patients pre-pay for a supply of medications, as opposed to administering medications, where patients are charged by each administered dose.

Second, in the State of Colorado, borrowing is defined as a diversion, and is a punishable offense.

"Staff gives patient “A” medication which belongs to patient “B”, because the medication for patient “A” is not available. Is this reportable? Yes, it is reportable. It was deliberate, and a diversion."

http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheadername1=Content-Disposition&blobheadername2=Content-Type&blobheadervalue1=inline%3B+filename%3D%22Occurrence+Reporting+Manual.pdf%22&blobheadervalue2=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251841695540&ssbinary=true this is on page 25.

Sorry, I'm on the iPad, and not as adept at putting in links on the thing as I am on my laptop.

The example given is where a staff member took a patient's medication for personal use, that is diversion. Re-appopriating medications that had been intended for a now D/C'd patient for another patient with an active order is not diversion.

The example given is where a staff member took a patient's medication for personal use that is diversion. Re-appopriating medications that had been intended for a now D/C'd patient for another patient with an active order is not diversion.[/quote']

No, if you re-read the example, the staff member took a medication from one resident to give to another resident. In Colorado's eye, still diversion, and it doesn't matter if it was d/c'd or an active prescription.

This is why I have an E-Kit at my disposal. So that I don't have to do this.

And as far as that proper documentation, IMHO, still stealing. It is up to you to decide what is worse, stealing and committing possible insurance fraud, or taking care of your patient in a matter that prevents distress yo that patient. Same goes for the diversion.

Specializes in Critical Care.
No, if you re-read the example, the staff member took a medication from one resident to give to another resident. In Colorado's eye, still diversion, and it doesn't matter if it was d/c'd or an active prescription.

This is why I have an E-Kit at my disposal. So that I don't have to do this.

And as far as that proper documentation, IMHO, still stealing. It is up to you to decide what is worse, stealing and committing possible insurance fraud, or taking care of your patient in a matter that prevents distress yo that patient. Same goes for the diversion.

That's true in a self-administration situation, the patient "owns" their own stock of medication, taking their medication is no different than taking their DVD's and giving them to another patient, it's their personal property. In a situation where medications are being administered from stock they are not actually owned by any particular patient even though they may be essentially intended for a specific patient, which is why it would be helpful for the OP to clarify which type we're talking about.

Muno, it was my understanding, that the Haldol was from a discharged patient, or was a d/c'd medication, not from stock or an E-Kit.

I agree, stock medication is different. In our case, stock medication belongs to us. We buy it and supply it. We supply all OTC medications.

First, in LTC, we return unused drugs for Medicaid reimbursement. If you borrow from a patient, then you are, in a sense, stealing because that drug will no longer be available for reimbursement.

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/LewinGroup.pdf

At the very least, this shouldn't be a problem for OP, since they aren't a Medicaid facility.

But still, when there's no alternative, what is the nurse to do? This is a SYSTEM problem and OP, being in charge of the system, needs to come up with an actual solution, rather than just saying, "Don't do that."

I'm not disagreeing, Wooh.

Specializes in Critical Care.
Muno, it was my understanding, that the Haldol was from a discharged patient, or was a d/c'd medication, not from stock or an E-Kit.

I agree, stock medication is different. In our case, stock medication belongs to us. We buy it and supply it. We supply all OTC medications.

It's certainly not unheard of for ALFs, ECFs, and hospitals to pre-allocate medications for specific patients (they are bottled, bagged, etc) by pharmacies either in-house or off-site which makes both administration and auditing easier, and are returned to the same pharmacies for re-allocation after discharge, but they are still "house stock" medications and are not the property of the patient until administered.

Specializes in Critical Care.

I think the main issue is that any time someone thinks a Nurse didn't do something the "right way" that would imply they know of a better way, yet I'm not convinced the OP knows of the better way (which is often to call the DON who is then responsible for obtaining the med, regardless of time of day or night), and seems more interested in finding fault than actually finding a fix for the problem.

It's certainly not unheard of for ALFs ECFs, and hospitals to pre-allocate medications for specific patients (they are bottled, bagged, etc) by pharmacies either in-house or off-site which makes both administration and auditing easier, and are returned to the same pharmacies for re-allocation after discharge, but they are still "house stock" medications and are not the property of the patient until administered.[/quote']

Honestly, that makes sense, and seems like it is a better use of available resources.

Are contingency supplies of "common" meds not standard practice? We have an insulin box filled with a vial or two of each variety of insulin when you have to break into it, either for a new admit or because someone didn't order as they took the last one, you fax the sheet inside to pharmacy and they bring you a whole new box the next day. We also have a box in each med room with about 100 of the most common drugs we use, anti-hypertensives, diuretics, statins, etc for the same reason, new admits, a change in Rx, etc. Every Tuesday pharmacy brings an entire new box regardless of how much might have been used out of it. Same thing for narcs, we need a valid Rx, but then pharmacy gives us authorization to "break in" so residents have coverage of their narcotic pain medication or Ativan-type drugs while we wait for their full prescription to come from pharmacy. Borrowing from other residents is pretty much unheard of in our facility[/quote']

the OP mentioned that she works in assisted living. In my state it is against regulations for an assisted living to have a contingency. Trust me..... we've looked into it. It was one thing that surprised me when I made the switch from SNF nursing.

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