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?

Specializes in Addictions, Corrections, QA/Education.
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 no! That is just wrong.:o

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

You know it's not allowed, but you do it anyway? I seriously don't get that. Do you not think that bad things can happen to your hard earned license?

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Specializes in LTC.
Nice . . . . . .:trout:

:yeahthat: Holy smokes.

Don't you guys have an e-box? I think you made the right call about circling it on the MAR as long as she was asleep. "Borrowing" from another resident?? I think the DEA and the state would maybe have sort of an issue with that...:banghead:

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Oh no ! I don't think so.

I am not a pharmacist so I cannot (in my LTC setting in Tx)

Give drugs prescribed for one pt to another pt. That isn't legal and if one of the pts is on medicare you would have been participating in medicare fraud.:o

Your facility is required to have a three day supply of meds on hand for each pt . And if the meds are not available ,it is the nurses responsibility to call the pharmacy and get them stated out.

Unless you work in a facility with an er box with narcs in it.

I have only seen that once in LTC in 14 years.

Just because the adon says do it doesn't mean you should. :bugeyes:

I guarantee administration won' t stand behind the nurse if it ever comes to light.

Also that don with an office full of d'cd narcs is diverting drugs.

I actually knew an rn don who lost her license for this.

Run away!

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Surely you have an EDK you can get your narcs from????!!!!!!!!!! and I mean the kind that is behind locked doors, in a locked box with forms you have to fill out etc., not the in the bag under the desk in the DON office kind

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OK, SERIOUSLY!!!!!!! I am the OP here and everyone that replied here should know that it is not only unethical to use another pts meds it is also a felony in almost all fifty states to user another pts narcotics. I know I asked for opinions, however I didn't know that there were so many people that didn't understand how the gov't stood on this!!! COME ON, let's get into the twenty first century!!!!

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And yes we have an ER (funny cause I'm an ER nurse in my main job) box for pain meds. Crazy that none of us thought of this!!!

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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?

Is that the patient's personal medication record (MAR)? Because putting another patient's name on the original pt's chart is a HIPAA violation. Just wondering.

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Specializes in Utilization Management.
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?
OK, SERIOUSLY!!!!!!! I am the OP here and everyone that replied here should know that it is not only unethical to use another pts meds it is also a felony in almost all fifty states to user another pts narcotics. I know I asked for opinions, however I didn't know that there were so many people that didn't understand how the gov't stood on this!!! COME ON, let's get into the twenty first century!!!!

I'm curious as to why you asked for opinions if you already knew the answer. Were you testing us?

:trc:

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NO WAY!!!!!! I would RUN from that place!!!!! They are violating multiple Nursing Practice Standards and Federal Laws!

Narcs are serious business hence the fact we must sign our lives away when using them.

Narcs are tracked and I for one know too many DEA and FBI officers to mess with "borrowing" a narc from another location or patient! "Oh btw Agent Joe what are the federal standards for using one person's meds on another....?" YEAH RIIIIIIIGHT! There'd be a black SUV in my driveway the next morning... LOL

I would sign and circle the MAR with a note stating med unavailable at this time. THen write in the nurses narrative note the same thing documenting how much was in the elixr bottle. I might even call the Dr. for a one time order to give the patent a reduced dose until the new bottle of elixr was obtained.

or an order for the narc stock box to be opened and the right dose removed. But I suppose the DON or the ADON has the key... LOL

Let the ADON get her toosh out of bed and come put HER license on the line! I'd be fired the next day, but would still have my license!

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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.

I missed the "pt" indicating that the nurses were supposed to borrow from another pt's supply of narcs; yeah, that's a bad career move, but I was certain that I worked on a floor or 2 where we had to go to some other floor's pyxis to get a narcotic from that floor's stock (not from a patient)--I think it was vicoprofen or one of the various hydrocodone/APAP meds.

So I'm a bit curious...in LTC facilities (or at least some of them), patients have their own supply of narcotics rather than a pyxis system with a general supply of narcs, benzos, and other controlled substances where you sign in, select a patient who you are pulling for, then select the medication, then pull the medication from the bin...or something like that? I assume those individual controlled meds are still locked up, right?

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Specializes in Utilization Management.

In my state, they have to be double-locked. As in your med cart has a lock and the narc bin is also locked.

In the med room itself, the narcs are locked in the ER box, and the med room is supposed to be locked at all times as well.

If you have to break open the ER box, you have to count all the meds with the oncoming nurse, relock it and record the lock number and chart what was taken, for whom, and the time.

Each patient has his/her own prescription and own narcotics locked in the narc drawer and all of these meds are counted at the beginning and end of each shift with the oncoming nurse.

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