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?

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.

Hey, I know it's wrong. That's why I stated it in the way I did. I think it's totally wrong. What do you want me to do? I stay away from it. I need my job. I'm not going to leave a place every time some easy come easy go DON makes a bad decision. I'd be quitting jobs every 6 months if that was the case. A lot of people on this board seem quick to advise people to quit their jobs. It's just not always practical. As I noted earlier I've been at this place for a long time. I get benefits, tuition re-embursment and a decent salary.

This is the way it is. I don't participate in it, but it's there. I feel like many of you are being hostile to me for just stating a fact. Not a very friendly environment.

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Sleepy, I don't mean to come off as hostile, it's just not acceptable procedure. And as for quitting jobs every 6 mos., I have done that too! My license means too much for me to lose it over some one else.

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I don't think jlcole was trying to be hostile. They were just pointing out the position of the OP should the feds come into the place. They would question everyone and determine who is complicit and who is innocent. And yes, they check out the internet like crazy. There's plenty of stories in my state about criminal activity being dealt with through checking out the internet.

I received info that my DON was stealing narcs at a place I once worked. I got fired for reporting the patient abuse that the person who was supplying the DON with narcs did in front of me. I went to the police with a written report because I was interested in saving my own behind when the situation came up, which it did. As far as I was concerned, I was protecting myself. I pretty much knew that nothing would be done about either the abuse or the theft of narcs, but I surely didn't want to be answering why I hadn't reported anything. Same type of situation, so please don't think that anyone is jumping down your throat or willy nilly telling you to quit your job. I didn't like working for a DON whose drug-induced megalomaniacal tirades grew worse by the day and would have left had she not fired me to protect herself and her pet who liked to hit old people. You really would do well to look for other employment. That place is a ticking time bomb. You don't need us to tell you that. Thanks for your original post. It has started an interesting and provocative dialogue about an important subject. Maybe somebody can be helped by reading this thread. Again, thanks.

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Specializes in Ortho, Case Management, blabla.
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'd say, "Hahaha, What?" I'd then put my two weeks in shortly thereafter. That's just me, personally.

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Specializes in ER, ICU, Education.

I'm not being hostile - just honest.

What you are doing is wrong. Period. Don't you know that?

You are putting your job, career, and potentially your freedom on the line by condoning this.

I don't want you to do anything. It's your job, career, freedom and therefore your decision.

But you are a fool if you think that be "staying" away from it will protect you, should it ever be discovered by the authorities.

I understand that it's not easy to just get a new job but you do have a choice.

You can choose to do something or choose to do nothing.

I am sorry that I offered unsolicited advice because you obviously don't want to hear it.

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Specializes in ICU, ER, OR, OR assist, ADON, DON.

Okay this is crazy. I am a DON in Texas. Almost all LTC's have a on call pharmacy unless they are in a very rural area. It is never ok ay to borrow form another persons medications. According to medicare and medicaid guidelines once a medication is ordered the recieved that medication must only be used for the person. Second your ADON needs to be fired. The nurse practice act clearly stated the you must carry out doctors orders as written by the doctor. Not no mention patient rights(i.e right form). You cant just alter the form in which a drug if givien without the permission of the doctor. if this did indeed happen the are multiple violations to nursing law depending on which state you live. If it texas it is a violation. Report it immediately to your DON. He or she can dicipline the nurses involved and not report them to the board using the Minor incident clause in the rules and regulations. However if he or she if not willing to report you must under rule 217.11 standards of nursing practice or 217.12 unprofessional conduct. This are all texas rules, however i hvae worked in many states and the rules are mostly the same just number differently. I would advise you counsult your State Board of Nursing Rules and Regulations as well as your state Practice Act.

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Well, as the op I can tell you this did happen. I have done extensive education on "not" borrowing meds since. Not only narcs but any meds. Hell it says it's against federal law right on the label. Anyway, I do, as most, live in the real world and realize that there are times, the pt. is outta digoxin and another pt. has the same strength, that one must do what one must do to "protect" their pt. I am working hard to make sure that this will never happen again!!! We do have an emergency box, not the right strength, coulda got an order for the right med, I know, not sure, as stated before, why I didn't think about it. Wouldn't have mattered since the EX, thank god, adon, insisted that her ORDERS be followed.

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Specializes in LTC.
Well, as the op I can tell you this did happen. I have done extensive education on "not" borrowing meds since. Not only narcs but any meds. Hell it says it's against federal law right on the label. Anyway, I do, as most, live in the real world and realize that there are times, the pt. is outta digoxin and another pt. has the same strength, that one must do what one must do to "protect" their pt. I am working hard to make sure that this will never happen again!!! We do have an emergency box, not the right strength, coulda got an order for the right med, I know, not sure, as stated before, why I didn't think about it. Wouldn't have mattered since the EX, thank god, adon, insisted that her ORDERS be followed.

Seems like that happens pretty frequently with Coumadin as well. PT/INR's come back, doc orders a different strength, pharm can't get it out until the next day, so you look for somebody else's who takes that strength. At one place, we had so many Coumadin people I suggested we keep house stock in all strengths and we couldn't do that cause who would pay for it? It's all about the bottom line, after all. :(

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Specializes in med surg, cardiac step down, rehab, geri.

any DON who keeps narcs locked up yet knows there's a key for her office is breaking many rules and I would never touch those meds in fact I would report it to the administration and or board of nursing I'm an LPN and the evening supervisor in a medical facility the rn's come to me for advice we keep a locked emergency narc box from the pharmacy with basics ativan vicodin duragestic patches etc and we can borrow a alt pain med from one pt to another with the don's consent and a supervisors signature only in emergencies not as common practice we will not let a pt be in pain because some one didn't order a med or get a hard copy script off to the pharmacy on time

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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?

i have not a problem with borrowing as long as its documented so its known where it went - so its known some employee isnt taking off with the meds.

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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..

would you be ok with your father being in excrutiating pain due to some nurses indescretion to not reorder his meds - and leave him in pain for hours until pharmacy could get there or would you rather a pill beborrowed from another eresident for the few hours and taped back into the spot it was taken from. i dont know many nurses who wouldnt borrow- even if it is againts the rules. it doesnt happen often with narcs box contigincy but it hsa on occassion happened when the narc box is out and no other way but to let the patient be in pain if you dont borrow. it may not be legal but i wouldnt hesitate to keep my patients comfortable- if they tried to reprimand me ( which places have ) i will fight to the end- even if it means loosing my job or license. i have been "talked to" but never went any father then that - and the rare times it has happened its amazing how all of a sudden for a while anyway everyone has meds and the stock box is full.

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