[FONT="Comic Sans MS"]i work part time in a long term care unit and part time in an acute hospital palliative care/oncology unit.
one of the residents was admitted to my oncology unit with abdominal pain nyd. she spent most of the time screaming, moaning, yelling, talking to herself etc... i wasn't working at the time but my coworkers had sedated her with 3mg of morphine. according to the notes, it was effective. now that she's been back from the hospital for a week and a bit, she screams, yells, moans, talks to herself and gets hysterical during rounds when we have to turn and reposition her and provide care. i assessed her and determined she was in pain. i know how to assess pain. so i gave her some morphine. it was effective and i documented that in her notes.
the next morning, my DRC came in (and on a saturday too) and apparently went ballistic because i gave the resident morphine. she took the vial of morphine away to be destroyed. we had a doctors order to administer morphine sc. but she took the vial away!!! she was overheard yelling in her office about "we don't do that here!" the order was not discontinued by the MRP, nor was there any documentation that she had made a "director of nursing care decision" and i don't believe that she can legally make a decision like that and withhold medication from a resident that i determined needed it.
can she legally do this without documentation? can she legally do this at all? is this reportable to the college of nurses?
at this point, i am seriously considering reporting her because she is with holding medication. can i report her?
the other thing is, the team is very suspicious that one of the RPN's is stealing narcotics from the patients. on the nights that he works, the residents don't sleep. the residents are in pain. residents apparently are receiving percocet but are still in pain. this morning it was noted that a resident was given three percocet yesterday and she recalls only having one. our DRC did the cognitive assessment. the resident does not have any cognitive deficits. we know he stole the pills!!! the DRC was confronted on this and she went right to him and named his accusers. shortly afterward he threatened one of the other registered staff. we have brought out concerns to her which she refuses to deal with. apparently, she's cleared him of any wrong doing. how do we deal with this? can she be reported to the college of nurses for failing to deal with this situation?
any help with these questions would help me a great deal
Nov 19, '06
I would report both to the BON. Obviously something is going on - take care, users often will sabotage others in an attempt to cover themselves so DOCUMENT everything!
Nov 19, '06
What a mess! No the director shouldn't be able to discard morphine! Are you sure she actually wasted it? If the staff has documentation theft of narcotics is happening, then incident reports and reports to the board of nursing, and the police if that person is threatening you. The patient's doctor should be notified stat that the patient is screaming in pain.....why all this is happening may not be obvious but to me the situation stinks to high heaven.