How would you tell your boss this?

  1. Here is the situation. I work in a residential facility for kids with psych/behavioral disorders. They currently give all kinds of OTC's with no standing order, just a consent upon admission from parent/guardian. I brought this up with the director twice--- both times she assured me we were covered just with the consent. I know better.....
    And another thing that bothers me.... the med "system".
    The kids are on lots of psych meds, with lots of changes, naturally. They come on bubble pak cards, from an outside pharmacy. When a kid is d/c, or a med is changed, they keep that med, and we use it to start another kid on it if we get an order or a new admission. They just cross the name out and write the new kids name. There is a closet FULL of meds. So when something new is started, we go to the cabinet, get it out and put that card in the kids binder. Now I know this isnt kosher, but I need something to go to her with, since she is obviously clueless that this cant happen.
    How would you approach this with her without sounding confrontational?
    Where can I get proof of this to show her?
  2. Visit RNOTODAY profile page

    About RNOTODAY, BSN

    Joined: Jan '06; Posts: 1,074; Likes: 457

    44 Comments

  3. by   TazziRN
    Who is the governing body for the facility? Report it anonymously to goose an inspection.
  4. by   ukstudent
    Someone is paying for those meds, either parents/insurance or state insurance. Are they getting a refund for any unused meds? If not it's called insurance fraud and stealing.
  5. by   RNOTODAY
    Quote from TazziRN
    Who is the governing body for the facility? Report it anonymously to goose an inspection.
    Nobody. Its a non profit agency. I would rather not report it, would rather "fix" it, because I really like working there...just dont know how to bring it up to her, and if she fights me on it, I dont know where I should tell her to look..
  6. by   RNOTODAY
    Quote from ukstudent
    Someone is paying for those meds, either parents/insurance or state insurance. Are they getting a refund for any unused meds? If not it's called insurance fraud and stealing.
    I thought of that too. But I heard, once the med is dispensed, there is no refund....so they would just be "wasted" anyway....
    BTW, I am in no way arguing with you, I am just repeating what I had heard as "rationales" for doing this. I just know that this is wrong on a lot of levels
  7. by   txspadequeenRN
    my personal opinion is your in a mess of trouble if you get caught. i wouldn't care about sounding confrontational . just lay it on the line for her because obviously she has no clue about the nursing aspect of your job. tell her that you need to implement some guidelines and policies to protect everyone if she wants you to continue to work there. i don't know much about residential settings but do you have a medical director ? or you could even use these children's regular pedi for orders. but this mess about re-using medications, that could be considered as practicing without a pharm license...i also think these practices put these children at a high risk for medication errors..oh lord i am just running with thoughts on this and it is not good... if you get caught on this ,i'd bet my last months pay (uhh you wont get much) you will visit the bon ...
  8. by   TazziRN
    Non-profit or not, there is a governing body. What state agency does she have to report to?
  9. by   SuesquatchRN
    Quote from RNOTODAY
    I thought of that too. But I heard, once the med is dispensed, there is no refund....so they would just be "wasted" anyway....
    :yeahthat:

    We do this all the time when we can't return a d/ced med, for emergencies in particular, taking great care that nothing is expired. My facility takes great pride in being compliant with the law.
  10. by   RNOTODAY
    Quote from TazziRN
    Non-profit or not, there is a governing body. What state agency does she have to report to?
    Really, we report to nobody......
    I saw some sticker on a door that said something about "national residential facilities" or something, but really, nothing that we answer to.
  11. by   RNOTODAY
    Quote from txspadequeen921
    my personal opinion is your in a mess of trouble if you get caught. i wouldn't care about sounding confrontational . just lay it on the line for her because obviously she has no clue about the nursing aspect of your job. tell her that you need to implement some guidelines and policies to protect everyone if she wants you to continue to work there. i don't know much about residential settings but do you have a medical director ? or you could even use these children's regular pedi for orders. but this mess about re-using medications, that could be considered as practicing without a pharm license...i also think these practices put these children at a high risk for medication errors..oh lord i am just running with thoughts on this and it is not good... if you get caught on this ,i'd bet my last months pay (uhh you wont get much) you will visit the bon ...
    no medical director.... we do have a psychiatrist on staff, but he does nothing but the psych meds. we take the kids to a peds office in the community.
    i hear your sense of concern, i have it myself. at first, i was like, i must be missing something, thinking that this type of facility was under different regulations. i just couldnt believe another nurse could be this clueless. i am going to talk to her about this , me and another nurse this week. i will quit over it, but i dont want to!!! i like this job..... there is no perfect job, i tell you. do you think we all could get in trouble, 4 nurses, if this is caught?
    does anybody know where i can get this in writing to show her????
  12. by   KrysyRN
    I think I would call the pharmacy that is supplying the meds to find out what the state laws are about relabeling the meds with a new person's name and dispensing them to that new person.
  13. by   EMSnut45
    When I worked in a detention center, we had MANY inmates on various psych meds that seemed to change constantly. To be able to deal with this, we had a "stock supply" of the main somatic and psych meds prescribed in the facility. When a new medication was ordered by the doc, we simply used the "stock supply" until the meds arrived in the patient's name. If a med was d/c'd, we had an agreement with the pharmacy where we returned any unused pills for a refund. We used bubble packs, so the pharmacy was able to tell that we hadn't handled the pills that were unused.
  14. by   EMSnut45
    Also... I was told that it is illegal to write on the rx label unless you are a doctor or pharmacist. This includes who the med is prescribed to. Hey, maybe I like seroquel... could I just cross out your name and write in mine? Is it really dispensed to me now?

    If you want a resource, try contacting your state nursing board. I found them to be really helpful when I had a question about the "correctness" of a situation. They advised me that the situation was not correct, and they launched an investigation. In the mean time, they were able to help me cover my butt so that I didn't become a bulls-eye myself.

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