Borrowing Narcs in LTC, ok?

Nurses General Nursing

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I supervise lpn's and cna's in a ltc facility. I got a call last night that a pt had only 10 cc's of Lortab elixer left and was suppose to receive the med at MN and 6AM. They had already talked to the ADON and this person told them to borrow a 7.5mg lortab from another pt, crush it and give it to her per her G-tube. They told her they were uncomfortable with doing this and she said to write on the sign out sheet "borrowed for (pts. name)" and to note "OK'ed per ADON". I asked them to not do this and that since the pt was sleeping to circle their initials on the MAR and note on the back, "pt. sleeping, lortab w/h." And then give the 10cc at 6am since she will be awake then. I also asked that they call another supervisor and ask her opinion. She told them since they had an ok from the ADON they had to do what she said since she was ahead of me on the chain of command. BTW, this was a few mins after MN and no backup pharmacy was available at the time. Thoughts? Opinions?

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I'm pretty certain I've seen floors in a hospital borrow analgesics from another floor. Some floors might not carry a certain type of narcotic so they have to go to another floor that does. I don't see anything wrong with it as long as there are witnesses who sign off on the borrowing. Is there something in the P/P forbidding such a practice?

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We are not allowed to write "borrowed". We have to write "wasted" and get a co-signer. Anyway, this doesn't come up too often as my DON has a big bag of narcs hidden in the office that we can just go in and get anytime we want! Yes, that's right folks, they save the narcs that they are supposed to be wasting on d/c'd pts. Anyone(who knows where the key is) can go in there and have themselves a big ol' party. Let's see there's oxycontin, percocet, dilaudid, roxanol, vicodin....

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Specializes in Neuro/Med-Surg/Oncology.
We are not allowed to write "borrowed". We have to write "wasted" and get a co-signer. Anyway, this doesn't come up too often as my DON has a big bag of narcs hidden in the office that we can just go in and get anytime we want! Yes, that's right folks, they save the narcs that they are supposed to be wasting on d/c'd pts. Anyone(who knows where the key is) can go in there and have themselves a big ol' party. Let's see there's oxycontin, percocet, dilaudid, roxanol, vicodin....

Nice . . . . . .:trout:

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We are not allowed to write "borrowed". We have to write "wasted" and get a co-signer. Anyway, this doesn't come up too often as my DON has a big bag of narcs hidden in the office that we can just go in and get anytime we want! Yes, that's right folks, they save the narcs that they are supposed to be wasting on d/c'd pts. Anyone(who knows where the key is) can go in there and have themselves a big ol' party. Let's see there's oxycontin, percocet, dilaudid, roxanol, vicodin....

I'd stay as far away from that office as possible. If the DON wanted to yell at me for doing something wrong, he/she'd have to yell at me at the nurses station or in the breakroom or restroom, or anywhere other than her office.

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
Anyway, this doesn't come up too often as my DON has a big bag of narcs hidden in the office that we can just go in and get anytime we want! Yes, that's right folks, they save the narcs that they are supposed to be wasting on d/c'd pts. Anyone(who knows where the key is) can go in there and have themselves a big ol' party. Let's see there's oxycontin, percocet, dilaudid, roxanol, vicodin....

My word. I can understand the reluctance to waste perfectly good medications, really I can, but if I were going to stash unused meds, it might be Amoxicillin or something like that. But narcs???

Never. Not in this lifetime. It would be a cold day in a very hot place before I did this. Your DON could get in so much trouble it wouldn't be funny. In my mind, narcs=feds, and I don't want to get the feds interested in me.

It doesn't matter that she may have the very best intentions in the world. This is a really, really, really, really bad idea.

To the OP: sorry, not trying to hijack your thread; sleepy's DON story just about made me fall out of my chair.

I would say that if the nurses don't feel comfortable doing it, they shouldn't, no matter who tells them to. Let the ADON come in and do it herself is she thinks it's OK.

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Specializes in Maternal - Child Health.
I would say that if the nurses don't feel comfortable doing it, they shouldn't, no matter who tells them to. Let the ADON come in and do it herself is she thinks it's OK.

I agree. Unless the facility has a written policy and procedure stating that "borrowing" of narcotics is acceptable, and how to properly do it, I would insist that the ADON come in and put her own signature on the narcotic log and patient chart. That would only have to happen once before she makes certain that patients have an adequate supply of narcotics to get them thru the night or weekend.

As for the other poster's DON with the narcotic stash, please tell me that no one here would ever jeopardize his/her license by utilizing unsecured and possibly outdated narcotics. Why hasn't the BON and Board of Pharmacy been notified?

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Specializes in LTC.
We are not allowed to write "borrowed". We have to write "wasted" and get a co-signer. Anyway, this doesn't come up too often as my DON has a big bag of narcs hidden in the office that we can just go in and get anytime we want! Yes, that's right folks, they save the narcs that they are supposed to be wasting on d/c'd pts. Anyone(who knows where the key is) can go in there and have themselves a big ol' party. Let's see there's oxycontin, percocet, dilaudid, roxanol, vicodin....

Oh my, that's bad, bad, bad. Run, don't walk, from that facility. That is a huge big fat hairy problem waiting to happen. And when you get out, hotline. Seriously.

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Specializes in ER, Occupational Health, Cardiology.
I'm pretty certain I've seen floors in a hospital borrow analgesics from another floor. Some floors might not carry a certain type of narcotic so they have to go to another floor that does. I don't see anything wrong with it as long as there are witnesses who sign off on the borrowing. Is there something in the P/P forbidding such a practice?

Borrowing from floor stock is not the same as "borrowing" from another pt, and using a different form of the med. I am with the OP on this. I would never have condoned that.

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Specializes in LTC, assisted living, med-surg, psych.

Holy crow!! I don't know what other states do, but here in Oregon, 'borrowing' controlled substances=federal narcotics law violation=BIG TROUBLE. The job-losing, career-ending, criminal-charges type of trouble. I wouldn't chance it even if the pharmacy was closed for the night and the patient needed the med NOW---there's usually an E-kit in nursing facilities, and if all else failed, I'd simply call 911 and get the resident to the ER for pain control.

And bright and early the next morning, I'd have a talk with the staff member who failed to order the drug before it ran out, and/or chew the pharmacy a new one for not delivering the meds in time. There's almost never a good excuse for not having residents' medications on hand, and in fact it's a violation of most (if not all) states' LTC regulations.

JMHO.

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I agree. Unless the facility has a written policy and procedure stating that "borrowing" of narcotics is acceptable, and how to properly do it, I would insist that the ADON come in and put her own signature on the narcotic log and patient chart. That would only have to happen once before she makes certain that patients have an adequate supply of narcotics to get them thru the night or weekend.

As for the other poster's DON with the narcotic stash, please tell me that no one here would ever jeopardize his/her license by utilizing unsecured and possibly outdated narcotics. Why hasn't the BON and Board of Pharmacy been notified?

In LTC it is usually not acceptable to 'borrow" any meds even non-narcs, we usually do it anyway.

As far as the other issue- I don't know what to tell you-that's just the way it is. I pretty much stay away from it.

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It sounds like SleepynDopey's DON may have a Narc problem. That is very bizarre behavior and highly unethical....let alone illegal no matter what state we are in. I would ? what really is going on with these Narcs and why is it just the Narcs. No...."somethin' fishy in Denmark"!

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