Advice please I’m torn.

[Yourfavoritenurse13, LPN]

TL;DR Home care nurse, mom is diluting Ativan, need advice.

Hello,

I’m a private duty LPN for a local pediatric hospital. I’ve been a nurse for years now so it’s nothing new.

Onward,

I’ve been coming to a home for awhile now, the child has hx of seizures and muscle rigidity. They’re given Ativan concentrate routinely, this is the primary method of seizure control. There is “known” diversion going on. It’s suspected mom dilutes (you read that right) her Ativan and leaves diluted ass medication for her disabled kid. Humanity.

Several of us have notified our respective supervisors, we were given the ******** advice to “document your findings” but not say that directly. I was asked to write a statement, in which I declined bc I’ve been burned in situations like these before.

The medication is dispensed 10-12 bottles at a time. Cyclically the child will start having a shit ton of seizures, and the medication will have a watery consistency. There are other “backup” meds to be given PRN but they’re not as effective.

Today I noticed the same watery bottle, so I looked at the three remaining bottles and the tamper seal is white, indicating they’ve been opened. They also were watery, not like the usual viscous Ativan.

My questions: I’m stumped bc giving a known altered drug seems like a huge liability. The kid is a few clusters from a grand mal that would do some damage. We’ve already told management who is apathetic and loose lipped, so any reports goes to this one senior RN who’s very tight with the mom. Again I’ve been used as the scapegoat and pissed on by management when they’ve ignored diversion, and it was discovered and they had to address it (hope that makes sense)

Any advice or input? I thought of contacting our in-house attorneys and asking. I’m just torn as if any of this **** hits the fan, we all know this has been tampered with, and hello, liability.

Ugh. I just wanna work and go home!

[KatieMI, BSN, MSN, RN]

1). You go to your boss right now and tell him/her in clear and simple English that you won't set your foot in that house from now on, period.

2). You call every single home care nurse in your agency to do the same ASAP.

3). Dust off your resume and start looking for another job STAT. If you can afford it, bring your good bye note today and take doctor's note for any remaining time.

4) . Keep copy of everything. I mean EVERYTHING. Picture on your phone with transfer as soon as possible on memory stick which you keep hidden and secure. If your boss(es) suggest a "meeting", do not go there alone.

Please protect YOURSELF FIRST. This situation is dangerous beyond all means for you. In-house lawyers won't protect you, they are there to cover your bosses.

Honestly, I would look for a TAANA lawyer right now. But the first and foremost action is to quit all contacts with that family

[JKL33]

You need legal advice asap.

You can't return to the home, you need to make clear that you are resigning and I suspect (but don't know) that it would be wise to carefully/neutrally document and inform them of your reasoning for such at the time of resignation from the case. I say this because there is no good reason to think you wouldn't become the subject of retaliation.

Especially since - according to my belief/understanding this should be reported according to mandated reporter laws.

[YuHiroRN, BSN]

This sounds like something that would fall under Mandated Reporter laws, easily. Or at least reach out to an ombudsman to see if it does. Regardless, protect yourself until you can reasonably not be a part of that care team any longer. Yikes, that mother screams Munchausen.

[Wuzzie]

Get a lawyer, get a hair test, don’t go back. I’m laying bets they’ll accuse you of diverting and that’s all it would take to seriously mess up your life.

[Lev, MSN, RN, NP]

I would not go back. I would start looking for a new job ASAP. This is a dangerous situation for you, your coworkers, and your company. If the kid dies from underdosing and it's discovered that staff "knew" there will be a huge legal nightmare.

This must be reported immediately to CPS (because the mother is causing harm to the child) and they can do an investigation.

I would also notify in writing your supervisor of your "suspicions" in clear detail and print out a copy of your email. In the email write that you would like to speak in person about this as well. In the email inform him that you are notifying CPS because you are a mandated reporter (even if there are suspicions) and the situation needs to be investigated.

Prepare to lose your job.

[Jory, MSN, APRN, CNM]

I have a better question, actually two questions.

1). This is not a mystery, send one of the bottles to the pharmacy.

2). Once you have evidence of diversion, call CPS yourself and report medical neglect.

You have reported it to management and they have ignored it. There is nothing in the law that will PROTECT you if you fail to report it to CPS and something happens to that kid.

[AdobeRN]

On 1/28/2019 at 4:56 PM, Lev said:

I would not go back. I would start looking for a new job ASAP. This is a dangerous situation for you, your coworkers, and your company. If the kid dies from underdosing and it's discovered that staff "knew" there will be a huge legal nightmare.

This must be reported immediately to CPS (because the mother is causing harm to the child) and they can do an investigation.

I would also notify in writing your supervisor of your "suspicions" in clear detail and print out a copy of your email. In the email write that you would like to speak in person about this as well. In the email inform him that you are notifying CPS because you are a mandated reporter (even if there are suspicions) and the situation needs to be investigated.

Prepare to lose your job.

Yes to this ^^^^^^^^. Get the heck out of there.

[KatieMI, BSN, MSN, RN]

17 hours ago, Jory said:

1). This is not a mystery, send one of the bottles to the pharmacy.

2). Go ahead and try to prove that it was not YOU diverting. Good luck.

There is a thing named "chain of evidence". Whoever disrupts it, willingly or not, out of good intentions or not, automatically becomes suspect until proven otherwise. Read about O.J. Simpson case in L.A. to see what it is about.

The O.P. already did enough to get herself into big trouble. She should not even appear near that family any more, much less touch any of potentially compromiced drugs without at least one witness.

[Persephone Paige, ADN]

This child is being abused, at best medical neglect. What's to keep the mother from saying you stole the medication, if you are not following through on contacting authorities? And drug screens are great for proving you didn't divert the medicine for personal use, but they do nothing for an accusation of diversion for sale on the streets. R-U-N to your nearest attorney!

[Jory, MSN, APRN, CNM]

2 hours ago, KatieMI said:

2). Go ahead and try to prove that it was not YOU diverting. Good luck.

There is a thing named "chain of evidence". Whoever disrupts it, willingly or not, out of good intentions or not, automatically becomes suspect until proven otherwise. Read about O.J. Simpson case in L.A. to see what it is about.

The O.P. already did enough to get herself into big trouble. She should not even appear near that family any more, much less touch any of potentially compromiced drugs without at least one witness.

Let's not create drama where drama doesn't exist. Nobody in her company accused the LPN of diversion. She has reported diversion. Most addicts don't report diversion, in fact, they won't even discuss it. She can take a drug test and if someone wants to accuse her of selling it? Well, they need proof of that as well. You can't get proof where it doesn't exist. Wishful thinking doesn't hold up in court.

She has absolutely nothing to see an attorney about. She needs to refuse to go back to the house and call CPS NOW! This isn't even a difficult situation. The liability she is referring to is if she pulls meds from a vial that is clearly diluted.

[Ruby Vee, BSN]

Report the situation, call CPS, but GET A LAWYER! It really sucks that people are this way, but they are.