Borrowing Narcs in LTC, ok?

[rogle34]

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?

[Reigen]

My father is in a long term care faciility.... I certainly hope that his medications are NOT being "borrowed" for another resident...What would happen if my FATHER needed his medication and he didn't get what he needed, with the borrowing episode?

I am sure that several authorities would like to know about that practice, from the insurance company that most likely helped with the expense of the medications down to the long term care regulation board.

Borrowing from another patient/resident's medication is not a good practice, I do not think it is what a reasonable prudent professional nurse should/could or would do. I do not think any State Board of Nursing would "back" the nurse up on this issue.

I certainly hope an incident/ variance report is made and copies sent to every one and anybody that should have them, insurance company, medical director, corporate headquarters, state omsbudman for that facillity,ect..

[AprilRNhere]

I know the nurses in the LTC facility I worked at as a CNA did this all the time. They occasionally ran into trouble. exp...."A" needed narc...so borrowed from "B"... suddenly "A" dies...and they obviously can't refill the prescription....so now "B" is short narcs and how do you replace them?

[MadisonsMomRN, BSN, RN]

To the OP, you wanted opinions right? I am confused... I do see that some of us got strayed away by the poster that said that her boss keeps all kinds of narcs in her office unlocked. Is that why you are upset? I just assume you got a little upset by your last two posts.

[catlynLPN]

I do not borrow narcotics. It would cause too much confusion on the books.

I just cannot be getting in trouble over narcotics.

I might borrow something that is non-narcotic, but what aggravates the h**l out of me is that I work weekends and you would think that the nurse who works during the week should take care of making sure everything is ordered so that we have enough of anything to last thru the weekend. The on call pharmacist will do stat orders like antibiotics but they do NOT like to be called to do a refill on a weekend, and I don't blame them.

There's plenty of time during the week to get things refilled, but some nurses just don't get it that we have a hard time with making do on the weekends.

[Altra, BSN, RN]

Staying away from the issue of the Party Box in sleepyndopey's DON's office ...

To the OP: another issue, among many, with the practice of "borrowing" is that it allows whatever system problem exists with failure to order & obtain needed meds on time to continue.

If a situation occurs where a regularly scheduled med is not available when needed, and attention is called to this situation, it allows the problem to be fixed. The creative solutions on the part of your ADON, while problematic for many reasons including some possibly criminal ones, mean that the problem will continue.

[rogle34]

Wasn't upset that the topic strayed, not a problem at all, happens sooner or later in every topic. Wasn't "upset" really, more shocked that it seemed this happened other places and that some didn't think it was problematic. I do appreciate all the opinions and thoughts, keep them coming. I did know the answer, yes, however we all know in real life the right thing is not always done. When I got to work yesterday yet another nurse had done the same, "borrowed" the lorcet from pt A to give to pt B. They passed it on in report that the DON was out till Monday and since the extra bottle of Lortab elixer was in the lock room in her locked office my nurse would have to "borrow" the lortab from pt A. My nurse came to me before doing it, not because she thought it was illegal but she was concerned that pt A was gonna run outta the meds. I did some education, called the ADON to do some more education, was told she was the ADON and I needed to remember that and do as told if I wanted to keep my job. I hung up with her and called the pharmacy to get a small bottle of lortab from the backup pharmacy to do until Monday. The facility will have to eat the cost of it, oh well. The main problem with the entire situation is the DON is new to the facility and noone seems to have a telephone number for her, by God if I won't correct that on Monday.

[gt4everpn, BSN, RN]

i've wondered about this myself, at my ltc when there are leftover narcs, either from a discharged or deceased patient ,percocet, etc.. they are used for whatever patients are low on narcs, this is what kinda gets me about nrsg, borrowing meds is a no-no yet some ltcs practice this! one time i had a patient who had pain but her percocet was finished i had to wait 2 hours for the supervisor to give me the pills, (she was busy i figure) the charge nurse then told me ''oh the lady has been waiting two hours and i could get written up...'' but what was i supposed to do steal the narcotic! one thing i learned about nursing as a new grad is that its a damned if you do damned if you dont type situation.

[caliotter3]

The LTC facilities where I worked had nurses who routinely practiced this "borrowing" of meds. Personally, as any prudent nurse, I didn't agree with it. Besides making those who are responsible aware of the problem, one action to take is to make sure meds are ordered on time if you have to do it yourself. On nightshift, I would leave messages on the pharmacy voicemail if I couldn't get hold of a person. To me, it was better than doing nothing. And I do wonder where the Emer locked supply was in all of this. Every place I've worked had an Emer box.

[MadisonsMomRN, BSN, RN]

Wasn't upset that the topic strayed, not a problem at all, happens sooner or later in every topic. Wasn't "upset" really, more shocked that it seemed this happened other places and that some didn't think it was problematic. I do appreciate all the opinions and thoughts, keep them coming. I did know the answer, yes, however we all know in real life the right thing is not always done. When I got to work yesterday yet another nurse had done the same, "borrowed" the lorcet from pt A to give to pt B. They passed it on in report that the DON was out till Monday and since the extra bottle of Lortab elixer was in the lock room in her locked office my nurse would have to "borrow" the lortab from pt A. My nurse came to me before doing it, not because she thought it was illegal but she was concerned that pt A was gonna run outta the meds. I did some education, called the ADON to do some more education, was told she was the ADON and I needed to remember that and do as told if I wanted to keep my job. I hung up with her and called the pharmacy to get a small bottle of lortab from the backup pharmacy to do until Monday. The facility will have to eat the cost of it, oh well. The main problem with the entire situation is the DON is new to the facility and noone seems to have a telephone number for her, by God if I won't correct that on Monday.

Gotcha! Its a sticky situation.

[Simba&NalasMom, LPN]

Wasn't upset that the topic strayed, not a problem at all, happens sooner or later in every topic. Wasn't "upset" really, more shocked that it seemed this happened other places and that some didn't think it was problematic. I do appreciate all the opinions and thoughts, keep them coming. I did know the answer, yes, however we all know in real life the right thing is not always done. When I got to work yesterday yet another nurse had done the same, "borrowed" the lorcet from pt A to give to pt B. They passed it on in report that the DON was out till Monday and since the extra bottle of Lortab elixer was in the lock room in her locked office my nurse would have to "borrow" the lortab from pt A. My nurse came to me before doing it, not because she thought it was illegal but she was concerned that pt A was gonna run outta the meds. I did some education, called the ADON to do some more education, was told she was the ADON and I needed to remember that and do as told if I wanted to keep my job. I hung up with her and called the pharmacy to get a small bottle of lortab from the backup pharmacy to do until Monday. The facility will have to eat the cost of it, oh well. The main problem with the entire situation is the DON is new to the facility and noone seems to have a telephone number for her, by God if I won't correct that on Monday.

How awful for you; it could potentially be awful for your residents as well. ADON sounds like a burned out so-and-so. I don't envy your position, but I do admire your judgement and integrity. All the best in getting this issue sorted. Personally, if it were me, and I had the proof I needed, I'd definitely follow the chain of command up to the ombudsman if necessary, but I'm guessing by what you wrote that it's a "She said/she said" type of deal.

[gt4everpn, BSN, RN]

the ltc facilities where i worked had nurses who routinely practiced this "borrowing" of meds. personally, as any prudent nurse, i didn't agree with it. besides making those who are responsible aware of the problem, one action to take is to make sure meds are ordered on time if you have to do it yourself. on nightshift, i would leave messages on the pharmacy voicemail if i couldn't get hold of a person. to me, it was better than doing nothing. and i do wonder where the emer locked supply was in all of this. every place i've worked had an emer box.

-the pharmacy we use is very often late with delivery of medications, often times we have to fax and call them multiple times just to follow up, also working per diem, i dont know what occured on the floor that week or the day before, so i dont know if someone ordered it! our emergency box only contains narcs and antibiotics! no help for regular meds, its one of those damned u do damned u dont situations again, huh!!:innerconf:o

[UM Review RN, ASN, RN]

I forgot to add something. For the patients that no longer need certain meds, especially narcs, they are given back to the pharmacy and credited back to the patient.