Borrowing Narcs in LTC, ok?

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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 LTC, Urgent Care.
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.

Your pharmacy takes Narcotics back? We have to destroy all narcotics, vicodin, ativan, etc. PA law won't allow pharmacies to take them back.

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Specializes in Education, Medical/Surgical.

An ideal solution would be to have a pharmacist "on call" with the extra fee charged to the NH. not to the patient.

You are not a pharmacist, therefore you can not dispense meds.

Your ADON is not a pharmacist therefore she cannot store/stock narcotics.

There are HUGE DEA felonies here. If the med isn't available then either circle the one where she is sleeping and put unavailable and make an occurrence report, or give that one and leave word to the day shift that they didn't leave enough and to get the morning dose STAT.

No bag rattling allowed. Occurrence reports cover your glutes. Stealing sits your glutes before the board and possibly in the jailhouse.

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Specializes in LTC.
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.

Are you at a hospital? It might be different. In OR, where I live, it's either not legal for pharms to take back narcs from LTC facilities, or it's against every pharmacy's policy I've worked with (either way, they have to be destroyed). I wish it were different; I hate seeing all the waste, esp. in a society where health care is rapidly becoming a luxury.

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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....

Well, I thought I had come across just about everything in LTC, but you got me with this one, Stashing narc's int he DON's office. We are required to keep them in the narc drawer for the pharmacist to come and destroy. Granted we're a small facility, but I have never heard of stashing. How do you keep track? How do you document when you gave one to a resident? Too much!

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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....
Ummmm...

I hope you're not working when the place gets raided.

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Your pharmacy takes Narcotics back? We have to destroy all narcotics, vicodin, ativan, etc. PA law won't allow pharmacies to take them back.
I had the same thought. Years ago, I was a pharmacy tech. We could never take back narcotics. And it would have been a record-keeping nightmare, especially with C-II narcs that have such strict record-keeping regulations.
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At the facility I work at we have back up narcotics that are locked up in one specific cart, there are 2 forms to fill out and the locks all have numbers on them. I don't know about any other state, but I believe that in MI it is considered fraud to borrow meds from another resident....now that doesn't mean its not done but I don't think it is done as often as it use to be. We also have back up ABT's, heart meds, IV meds, and so on. Maybe your facility should look into something like this.

Dee

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Ummmm...

I hope you're not working when the place gets raided.

I tend to stay away from it. Anyway, my facility has had 5 DONs/administrators in the past 3 years. Some good, some bad. The ones at this time are bad. I'm waiting them out. I've been with this company (hospital then transfer to rehab) for over 10 years. I'm not just going to quit because of these. I watch my back. ;)

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#1, I've never seen a situation where it's legal to "borrow" any meds from another resident, let alone narcs! #2, here in Arkansas, we have to have a 24 hr. backup pharmacy. In the case of a "surprise" admission, we have to have meds in the building within 2 hrs. of the arrival of the resident. #3, as for narcs in the DON's office, I wouldn't be working there!

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Specializes in ER, ICU, Education.

I agree with the others. It's called covering your butt!

They (feds) have gotten so careful and focused on monitoring controlled meds in the last 10 years or so. Hence the advent of Pyxis machines and the demise (thank God) of counting ALL the narcotics on the floor at the end of shift.

It sounds like the DON didn't want to come in and open up the pharmacy and dispense the med - or call the appropriate person in. But guess what? She/he should have because I'd be willing to bet money that it's the policy - that when a patient runs out of meds (or new ones are ordered) after the pharmacy is closed -- NOT that you can borrow narcotics from another patient.

If I were you I'd look for another job.

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Specializes in ER, ICU, 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....

This is wrong on so many levels .....

By the way, you do know that anyone can sign on to this site and read the posts? Don't you think that the feds are smart enough to track down your identity if they wanted too?

And if what you say is true, that you would go to jail right along side of your DON as an accomplice?

You've admitted that you know that they are committing a felony and that you have done nothing to stop it or report it and you continue to work there.

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in a hospital they have stock narc so if yo go to another floor and sign out for a patient you put down the patients name, your signature and have a nurse from that floor co-sign with you

totally different matter in a ltc facility with medicare or state funded residents..you would have to be

in effect stealing a med for the other person

guess what the adon is going to say if you get caught?? oh yes i authorized that i don't think so

as for the narc in the don's office..i know what those are they have been listed as destroyed which requires don and adon to witness and makes any nurse who knows about this as guilty as they are

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