Prescription of narcotics - who is liable for misuse?

[OrthoNutter]

We recently sent a pt with chronic pain home with a script for further narcotics when his hospital supply (seven days) ran out. He lives in supported accommodation (like a nursing hostel) and has to be responsible for his own medication. He is capable of looking after this himself and we weren't concerned about sending him home with narcotics.

However, it was brought to our attention that he was giving some of his narcotics to another resident who was complaining of pain, unrelieved by simple oral analgesia. She took the narcotic and the staff at the hostel had to call an ambulance because she had an acute anaphylactic reaction. She's perfectly okay now after a short stint in intensive care but she is lucky that there were people around when she took the pill.

I'm just wondering what the repercussions might have been if she had died. Who would be held accountable??? I can't seem to find any information on this issue.

[canoehead, BSN, RN]

I think that the person who places the pills in their mouth and swallows them is responsible for knowing the effects. So if she takes the meds again knowing she will have a life threatening reaction then that is her choice. If he supplies the med then I'm sure that since it is a controlled substance meant for him that he would be in trouble in some way.

Obviously if he tells her "it's OK you'll be fine" when he knows she could die he is misrepresenting. And in trouble especially if he sold the med to her.

But making the hospital responsible...that is silly. Maybe we could but in perspective- if this med was not a narcotic- say aspirin- the conclusion is more obvious. Or if a neighbor decided to take a portion of a PCN Rx. The med was meant for the person it's prescribed to, and any other use is not your responsibility.

[skwirm]

I have no idea about the acutal legalities of the situation, but It would make sense to me that if your patient was deemed competent, then anything he/she does outside the hospital is of their own accord and they are accountable, or anyone they associate with for that matter. It would be no different if a person were to buy a bottle of Tylenol at the drug store and then lend it to their friend who ends up taking too many and overdosing on it. I don't see how the drug store or pharmacist could be held liable. Then again you seem to be able to sue anyone for anything in the USA.

[micro, RN]

k'

i'll bite here......

i have always argued with how we handle narcotic discharge scripts around here, but no longer......

where i am at.....we do not send any medication home with patient from the hospital unless special and I mean VERY SPECIAL AND CORRECT ALLOWANCES HAVE BEEN MADE.............

otherwise, the only thing that gets sent home with the patient is an already opened bottle of insulin that is prescribed at discharge anyway, etc........

but nothing otherwise.........

makes and gives you time to pause when you see what your fellow coworkers have to question and deal with?????

hang in there you all

micro and out

[MPHkatie]

This topic comes up on another board frequently. It is the patient who gave the other person the medicine that is responsible. What that pt did is illegal - you and the MD who prescribed it are not at risk, as you didn't ever instruct the pt- give this med to anyone you think might like it." So the original patient could actually be held liable for giving another person a prescription medication and not being a MD. It has been tried in a court of law and I believe the sentencing was practicing medicine without a liscence. A little severe, but in that case the unintended patient had some serious consequences. And, the unintended patient was a minor. (mom or Dad treated with meds from their script- wrong med wrong dose, I can't remember details, I read about it in some nursing mag a few years back.)

[OrthoNutter]

I just can't believe this patient was so stupid. He came back into hospital recently and if not for the fact that I value my license, I would have damn near shoved him head first into the wall. The MD who originally prescribed the narcs has decided that he's not taking any more risks, so he refuses to give this pt any more narcs. Which means that we can't get rid of him until we find a non-narcotic equivalent that manages his pain. I can't help wondering what good that will do. People can still be allergic or be super sensitive to other drugs as well. I tried telling the MD that but I don't think he's interested in listening at the moment.

[Tiiki]

The patient who doled out the pills is completely responsible. Being oriented and comptetent, I'd have to agree with the others, that it is NO different than handing out an OTC med. You can have an allergic reaction to almost anything, narcotic or not. Once the patient leaves your facilities..you are no longer babysitting them. The episode was unfortunate. You didn't say whether the person who reacted was also competent. If so, they willing accepted the medication. So the blame is two-fold in that case then.

Just my 2 cents worth! )

Cheers!

Jo-Anne