Thoughts on "borrowing" meds

dudette10, MSN, RN · Feb 28, 2012

My question to your scenario--and to the people who say it's illegal and diversion--is, "What's the alternative?" Should we not give our patients their needed meds due what is essentially a supply issue?

Right med? Check. Right time? Check. Right dose? Check. Right route? Check. Right patient (in the basic sense)? Check.

If every nurse would write, "Med not dispensed for this patient" on the MAR at med pass time, would things really change, or would nurses be held accountable yet again for something that other services failed to do?

Every post I have made today is filled with irritation. For that I apologize. :/

bigcntrylady · Mar 1, 2012

This is also done in the LTC facility I work in, but there if follow-up paperwork that corrects it, to my understanding.

For example, if I borrow a med from Jane Doe to give to Jimmy then I have to call the DON and explain that the med is not

available for Jane Doe and that Jimmy is on the same med. With her approval, we then fill out a replacement slip that is faxed to the on-site pharmacy for replacement to Jimmy. Therefore, there is a paper trail for the "borrowed" med. It is my understanding that this is the correct way to do it. Although our facility discourages this sometimes it is unavoidable to ensure all patients receive their meds. Just my two cents.....

whatever... · Mar 2, 2012

I think it is time for your work place to come into the 21st century and get some of the advances you are talking about. Then I think you wouldn't have this issue anymore.

Double-Helix, BSN, RN · Mar 10, 2012

If you borrow a med from another patient, then there needs to be documentation as to why the med was not available, whom it was taken from (How many pills were present before removal, how many were removed, how many were present after removal) and whom it was given to. Then the pharmacy needs to be notified of the difference so that they can provide replacements.

If you just take a med from Mr. B and give it to Mrs. C without documenting that, then it could be considered diversion. When the next shift counts the medications, there will be pills missing from Mr. B with no documentation as to where the pills went. Simply saying, "Oh, I took it and gave it to Mrs. C." will not hold up in court and you will be liable for the missing medications with no proof that you didn't take it yourself.

You should definitely check with your DON about what to do in this situation. Find out what your facility's policy is related to "borrowing" and stick to that.

MrChicagoRN, RN · Mar 12, 2012

I was told that this was "diversion" and "beyond the nurses scope of practice" as it indicated the nurse "prescribing" a med and "illegal" because meds would be taken from a person prescribed that med and given to another person. Any thoughts? This practice has gone on as long as I have been a nurse (33 years) mainly in nursing homes and residential facilities.

I think that that interpretation of the law is really a stretch, but it is usually a regulatory violation to share meds; especially so if it involves narcotics or other controlled sunstances

But, your patients have needs to be met

If this is a recurrent issue, is it possible to have "floor stock" where you could sign out medications from a locked cabinet?

Makethemwell2 · Mar 16, 2012

I have read these posts for quite some time but it was not until i read DUDETTe 10's comment. This is a prime example of what is going on in Nursing. The Nurse bare the burden of everything and it is not right! Even here the comments are to TELL YOUR COMPANY IT NEED TO UPDATE...and other suggestions that put the responsibility on the nurses!...I did nursing home care for just over a year but that was enough for me!..I love the elderly but the lack of not only the facility and State...yes, State taking responsibility for what is going on in these and other places. And who the heck do you tell!!!!!!!!!!! when everyone already know!!!!!!!! I loved my staff and patients but the system was set up that you had a VERY GOOD CHANCE OF LOSING YOUR LICENSE! doomed if you do and doomed if you dont system!...It is so sad though! It has been many years and im still tramatized!....Even when i was a CNA breifly, i was a teenager, young and naive as i watched the State come in and check the bottom line. ie: So many hours had to be accomulated (Nurse to Patient and CNA to Patient..ect) but we all know how the one facility will call the other to inform them that "THE STATE WAS HERE AND ARE ON THE WAY TO YOU NEXT" I totaly get that part but when they work you like a freaking hourse all year, dont hire any extra help, or call in anyone when another call out ...just put the patient load on you!...MONEY SAVED FOR THE FACILITY ....then you walk in around the last few months around the time state comes in and you see staff you never see from other shifts, everybody working the floor! overtime galore! then once hours/quota is met and State see the BOOKS or NUMBERS look good...then all is well! Never mind the patients are poorly cared for or neglected all year..as long as you make it look good on paper when State comes!..Its a shame..a real shame!.....and if this is not the way it works...how is it that nothing is done about the lack of staff all year...every year the same darn game! I worked at a place where i did not last a month ( hired right before state due to arrive soon, per a staff person) and when i firstdid my orinentation there was feces all over the curtains that seperated or susposedly gave privacy to the patients who where two per room. I came in probablly a week later and they all had new curtains. I said something like "wow this is nice everyone's got new curtains." She looked at me and continued with the patient and said " Child these are not new they put these up every year when State come and then soon as they leave they put them same old nasty curtains back uP!" i WAS MORTIFIED! AND SCARED AT THE MIND OF SOMEONE WHO WOULD DO THIS! Why not just leave them and wash and care for them for the patients sake if not for the staff who prob. caught some of everything handling them while pulling them open and closing them!...Now nursing homes im sure have come a long way since then but not far enough!.................iT IS THE RESPONSIBILITY OF THE MANAGEMENT (DON, ADMINISTRATOR,) TO ENSURE THAT THERE IS A PROTACOL IN PLACE FOR NURSES WHO ARE GIVING MEDS...IF THEY ARE NOT THERE AND THEY SHOULD BE! BUT IF NOT THERE SHOULD BE A PROTACOL IN PLACE FOR THIS AND ONE THAT DOES NOT INCLUDE BORROWING MEDS! THIS PUTS THE LIABILITY ON THE NURSE AND JUST AS DUDETTE WROTE...NURSES WILL BORROW AND GIVE AND SIGN OFF TO COVER THEMSELVES BECAUSE THEY DONTFEEL THEY HAVE A RECOURSE! OR IF I NOTE ITS NOT THERE AND SOMEONE ELSE DOES NTO THEN WHERE DID THEY GET IT FROM ?( INCONSISTANCY) IF IT IS A NARC. OR A MED THAT WILL CAUSE ALMOST IMMEDIATE BAD OUTCOMES BECAUSE IT IS NOT ADM. THEN THE NURSE FEEL SHE HAS TO BORROW IT AND LET THE OTHER HONEST NURSE FIGURE OUT WHAT TO DO...JUST WRITE NOT AVAIL...WHO YOU CALLED AND NOTIFIED, D.O.N

DR PHARMACY ECT..AND MONITOR YOUR PATIENT..MAKE GOOOD DOCUMENTATION AND GO HOME! IF WE KEEP COVERING FOR THESE PEOPLE THINGS WILL NEVER CHANGE! WE NEED AN OUTAGE TO...T..E..LL!! TELL! TELL! IM SERIOUSE! YOU TELL NOW AND you MIGHT BE THE ONE HUNG! THATS JUST WHAT IT IS! so to dudette i say " TRY A DIFFERENT TYPE OF NURSING...HOSPITAL HAS A GREAT SYSTEM, HAS ITS ONLY DEMON NURSES BUT AT LEAST YOU CAN FIND STRUCTURE AND PROFESSIONALISM!......AND THE MEDS YOU NEED! YOU WILL DO GREAT! AND THANKS FOR YOUR POST..SORRY THIS IS SO LONG BUT I WAS BACK AT THE NURSING HOME FOR A MOMENT:)

Makethemwell2 · Mar 16, 2012

Call who you need to call about the med. not being there. Notify your SUp, DIr , Doc, Pharm and what they tell you to do and dovument it A NURSE'S BEST FRIEND IS THAT CHART...DOCUMENT DOCUMENT DOCUMENT! I KNOW ITS HARD THOUGH BECAUSE WHAT SOME DONT KNOW IS THEN YOU ARE IN TROUBLE FROM THE INSIDE, BECAUSE YOUR BOSS DONT WANT TO KNOW. THEY GIVE US STRAW AND TELL US TO BUILD A BRICK HOUSE! JUST GET IT DONE AND DONT TELL ME WHAT YOU DID SYSTEM! I WOULD DOCUMENT DOCUMENT DOCUMENT AND LOOK FOR ANOTHER JOB SINCE THEY MAY TRY AND MAKE IT HARD FOR YOU TO KEEP YOUR JOB WHEN YOU START DOING THINGS RIGHT..TRUST ME I KNOW. EVERYONE WANT YOU TO DO WHAT YOU WANT TO DO AND KEEP IT MOVING BUT IF YOU EVER HAVE TO SIT BEFORE THE BOARD TRUST ME THEY, YOUR CO-WORKERS AND BOSS WILL ALL THROW YOU UNDER THE BUS AND SAVE THEMSELVES!

Makethemwell2 · Mar 16, 2012

I meant...everyone want you to do what you have to do and keep it moving!..sorry im irritated and had all this pinned up...its a beast out here..but i still love nursing..you just got to find the right place!

nurseprnRN, BSN, RN · Mar 17, 2012

please don't shout! all caps is considered shouting in our terms of service. and it is so hard to read.

i agree with the basic premise of document, document, document. the system of having a slip to account for a borrowed dose and get replacements sounds like a good idea.

"diversion," as i understand it, is a term that describes taking meds from a patient or facility for one's own use, so that loaded term may not be appropriate here. people who lose their licenses for drug diversion are usually stealing controlled substances, not giving mr. c's colace or amoxicillin to ms. b, whose drawer for those meds prescribed for her is inexplicably empty.

as always, i am willing to be corrected if someone can cite chapter and verse from a law or regulation.