Discovered a possible diversion of meds, now what?

[msnurse123]

I am a float nurse in a large hospital. I have been working there for over 19 years. I was working today and actually went back to the same unit I had worked the day before, which doesn't happen often. During a quick update during report from the prior nurse on a certain patient who had some confusion with the dilaudid I had given him the day before, she reported to me that he hadn't asked for pain medication at all during the night. He had a very uneventful night, she said. During my am med pass I noticed that Dilaudid actually was given to him that night, but not by the nurse who was assigned that patient. He had an order for Q2 Dilaudid, 1 mg. The patient had prior to that only been given the medication once by me after a procedure. Like I said, the reaction was not favorable. So I was wondering why this med was documented in the emar as being given twice by a nurse who did not even have patients in the same area of the unit. I looked up the administration record and discovered the nurse had taken the Dilaudid out of the pyxis at 6 am. The emar stated that the patient was given the med at 8pm, then again at 10pm. This nurse had taken the med out hours after she charted it as given!!

I then asked the patient if he had any pain meds the night before. He said no, and he was completely alert and oriented. Also, this nurse charted the meds given as a late entry at the end of her shift, med was not scanned and neither was the patient id band, was a manual entry. I am so sure this nurse diverted meds. I told the charge nurse of my findings and she tried to rationalize it, but soon discovered she couldn't. I am distraught about reporting someone, as I have never had to do this before. Did I do the right thing? This is a fairly new nurse and she is well liked on her unit.

[APRN., DNP, RN, APRN, NP]

Unequivocably yes, you did the right thing.

You did not report a nurse out of malice.

Imagine how you would feel right now if you did NOT report what you are so sure of happening?

[Glycerine82, LPN]

You sure did, and you might have saved her life. Nothing for you to feel bad about, whatsoever.

[chiandre]

If you did not report it, you may be blamed for aiding and abetting. That nurse is a dangerous practitioner if she does not get help for her addiction.

Just in case the charge nurse decides to cover-up this incident, make sure to keep a journal of the name of the charge nurse and the date and time that you reported the incident. Additionally, incident report should be generated.

[msnurse123]

Chiandre, Should I have made an incident report myself? I was thinking that going to the charge of that unit was enough. I feel like I am already black balled for reporting this incident. This is a very tight Intermediate Care Unit. I have real reason to believe this is not the first time this nurse has done this. I am worried for her patient's safety! I am not sure if she is impaired or not, but she is definitely taking this medication for some reason. It has to be stopped. I am thinking i should talk to MY boss about this tomorrow!

[chiandre]

Chiandre, Should I have made an incident report myself? I was thinking that going to the charge of that unit was enough. I feel like I am already black balled for reporting this incident. This is a very tight Intermediate Care Unit.

Yep! You should make the incident report. You found the incident, you should make the report.

As for what other people think, no worries, you have the professional duty to safe guard your patients and your license.

[caliotter3]

Based on the initial reaction when you first reported the situation, yes, you should make the incident report and definitely report it to your supervisor. Also make the written record of what happened for your own file. This will probably come back to bother you and you want to be able to remember all the details.

[edmia, BSN, RN]

I'm just curious about the incident report: why write one? The incident did not harm a patient, so why write it? Just to have a written record of the accusation? I don't know, it doesn't seem to fit the definition of an incident report to me, but I've never been in this situation either. Going to the manager would be enough for me.

I'd love to year opinions on the report aspect.

OP: yes, I would report this to my boss as well to make sure things get investigated.

[Mulan]

I'm just curious about the incident report: why write one? The incident did not harm a patient, so why write it? Just to have a written record of the accusation? I don't know, it doesn't seem to fit the definition of an incident report to me, but I've never been in this situation either. Going to the manager would be enough for me.

I'd love to year opinions on the report aspect.

OP: yes, I would report this to my boss as well to make sure things get investigated.

To CYA?

Maybe no one was harmed but I would say it was a Risk Management issue.

What if the charge nurse/manager decides to ignore the verbal report for some reason?

What if someone decides to turn it around and accuse the OP of something instead?

What if it comes out later that the OP knew about it but supposedly never reported it?

A paper trail should take care of that.

[morte, LPN, LVN]

the patient is/was potentially harmed, now it looks like he can take this med, when in reality he shouldn't.

[SionainnRN]

If the pt had a poor reaction to the dilaudid why wasn't it dc'd? OP good on you to report it. Do the incident report because we all know there are managers who will deny till they're blue in the face.

[edmia, BSN, RN]

the patient is/was potentially harmed, now it looks like he can take this med, when in reality he shouldn't.

Right! I forgot about the reaction.

I understand what the incident report is for, I was trying to understand how to best justify this particular report.