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giving meds with other name on them

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nurseat52 nurseat52 (New) New

I recently started a job at a detox. We administer "comfort" which consist of clonidine, flexeril, and visterol. The meds are kept in a med cart. The issue I have is these med cards could have a name of a patient that hasn't been there in weeks but we just keep using the meds until they are gone, giving them out to the new patients. The new patients do have a script for these meds but when they get delivered from pharmacy they go in a pile for future use. Could I lose my license giving the meds because the patients name isn't on the car oor am I covered because they do have a script for the meds? Help, new nurse and nervous

BrandonLPN, LPN

Has 5 years experience.

A better system would be to just have stock med cards of catapress, vistiril and flexiril in the cart. No patient name necessary. Each card is clearly labeled with the name of the medication and the dose.

As for losing your license, Im going to guess these cards with patients' names on them still have the name of the medication and the dose on them. And you have a valid doctor's order. So I do not see how it is a med error.

But if you're giving out these three meds all the time, it seems it would be wiser to order them as stock meds. Is there some sort of billing or reimbursement reason each patient has to have their own card of these meds?

By giving a med with another patients name on it you aren't following the "right patient" rule and I think there could definitely be consequences if the state catches this...not sure exactly what they would be but I would definitely be concerned for my license just as you are.

I agree with the PP, see if the pharmacy can send up the meds w/o names eliminating this problem all together.

It does have to do with insurance, because some patients insurances do not pay for these meds so the meds are only filled if they are covered. I think by doing it this way the detox is not paying for stock meds. Thanks for answering, I was nervous because it was drilled into my head in school to check name and patient at least 3x to make sure correct med and patient. I will breath a little easier next time I work

If you know that a surveying party is in the house, make certain to pull from the patient's own med card during your shift. That way you do not have to worry about getting caught pulling from a different med card.

calivianya, BSN, RN

Specializes in ICU.

I would personally throw all meds from discharged patients into the discharged patient bin and request new, re-labeled meds from pharmacy to cover my butt. It shouldn't be that hard to get the meds re-labeled instead of grabbing meds under a different patient's name.

I just wanted to reiterate that you should by no means be "more at ease" next time you do this. Although your patients may be on the same exact drug/dose, giving medication prescribed to someone else is ILLEGAL. Talk to pharmacy ASAP and use only the patients specific med pack until this problem is solved.

Farawyn

Has 25 years experience.

I would personally throw all meds from discharged patients into the discharged patient bin and request new, re-labeled meds from pharmacy to cover my butt. It shouldn't be that hard to get the meds re-labeled instead of grabbing meds under a different patient's name.

Agree completely. As tempting as it is to just keep going, don't do that.

Right med, right patient, right day, right dose, right route, right time...right?

Edit: Wait, that's 6. I added one. ???

Edited by Farawyn
Confusuion on my part.

BlueChocolateCat

Specializes in CVICU, CCRN. Has 2 years experience.

I understand thats "how things are done" on your unit, but it does not reflect best practice at all.

Meds are dispenced from pharmacy with a patient label for a reason. If I were you, I seriously encourage this practice to end.

heron, ASN, RN

Specializes in Hospice. Has 40 years experience.

I think it would be considered insurance fraud. The facility is using meds paid for by insurance for other, uninsured individuals. Consider dropping a line to your risk management people.

I think it would be considered insurance fraud. The facility is using meds paid for by insurance for other, uninsured individuals. Consider dropping a line to your risk management people.

That is exactly what I was thinking when I read OP's post. If Medicare or Medicaid are involved, this practice could also be seen as fraud against the government. Not a good situation.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Providing a patient with their own medications and administering medications are two very different things. Non-licensed caregivers are limited to providing patients with medications that have already been designated for that patient. Licensed/registered nurses are allowed to administer, which makes who those meds may have been intended for at one point in time irrelevant.

In medication administration, "right patient" refers to the patient on the order the nurse is interpreting. So long as the nurse is interpreting the order that is for that patient, and administering the medication stated in the order, it makes no difference if that med was in another bin, since having patient specific bins or supplies only makes it easier to locate the medication that the nurse is still going to have to evaluate based on the medication identifiers themselves (not who the med was stored for).

This typically doesn't make a difference in billing either. If what you're doing is supplying the patient with medication they supplied to facility then that would be an issue, but otherwise medicare and insurance companies are paying for each medication administered, it doesn't matter if the facility bought x amount of medications for the purpose of administering them to a certain patient, they can only bill for medication actually administered so it makes no difference to medicare or insurers who the facility intended to provide those medications to when the facility purchased them.

AdamantiteEnigma

Has 13 years experience.

In my limited opinion, I would postulate that going to an RSDA or stock medication model would serve all parties well. Of course, most facilities I've seen so far avoid this model to relieve required paper work increases onto the medical staff.

It is something worth bringing up to Nursing Management at your facility. Perhaps it's a model they can embrace, as it is more efficient overall. But the paperwork.... ugh.

NurseSpeedy, ADN, LPN, RN

Has 18 years experience.

I think it would be considered insurance fraud. The facility is using meds paid for by insurance for other, uninsured individuals. Consider dropping a line to your risk management people.

I'm with the quoted poster on this one. I worked for a LTC facility that had a pharmacy that was absolutely horrible for filling vital meds in a timely manner (say, new admission three days earlier and they 'forgot to send the nitroglycerin' with the admit meds three days earlier and NOBODY followed up and now they are having chest pain! What do you do?! I'm not answering that one). Basically the policy was (and I'm pretty sure there are laws in place about discharged patients meds and what happens to them within a time frame...) that when the patient was discharged/deceased etc the POA decided if they wanted the meds or not. They paid for them or at least the copay. They owned it essentially (I don't agree with that in the case of deceased but this was the policy the company had). If they did not want it or did not come in to pick it up within a given time frame then the medication went back to the pharmacy if the med came from our pharmacy. If it was from and outside facility, then we used a third party where we filled out a form with how many pills were being discarded and the reason. A copy went in the permanent record. Right before I quit there was a crush/dilute with water/ witnessed by two nurses/ and mixed in cat litter method with a written file as well but I never actually got to see how that one worked.

Basically it sounds like your company is skipping out on paying for uninsured patients meds by using the script that BELONGS to another patient. Can something happen to you personally in the legal sense? I'm not in the position to answer that question nor do I truly know the answer. However, what your company is doing is unethical in order to save their own money and I'm pretty sure illegal when it comes to how they obtained the medication and who they are giving it to. No pharmacy even dispensed the medication for the patient that has the new script that wasn't filled on admission. It belonged to another patient. I wouldn't feel comfortable doing this and they are asking you to do it on a daily basis which is bad.

The problem is that if it's stocked and labeled in that patient's med cart, they are being charged for those meds one they are deposited by pharmacy. That is why you should not give them to another patient (other than that it violates the 5 rights). Ask for pharmacy to stock those meds in the accudose for single use, or unfortunately, you will need to return the discharged patient's medications to the pharmacy so they are not charged for unused and unopened medications. Then, have pharmacy stock the correct meds for the correct patient (if you can't do the accudose thing above).

I think it would be considered insurance fraud. The facility is using meds paid for by insurance for other, uninsured individuals. Consider dropping a line to your risk management people.

Don't do this. You would be unnecessarily going over your boss' head.

What does your boss say about this practice? Is the boss even aware?

The best advice I see here so far is to send meds of discharged patients in the "Return To Pharmacy" bin.

I just hate situations like this. Why do people do this sort of thing? Why is it being done at your place?

If you are going to go over your boss' head, do it anonymously - if you haven't already been talking about this with anyone where you work.

I'm with the quoted poster on this one. I worked for a LTC facility that had a pharmacy that was absolutely horrible for filling vital meds in a timely manner (say, new admission three days earlier and they 'forgot to send the nitroglycerin' with the admit meds three days earlier and NOBODY followed up and now they are having chest pain! What do you do?! I'm not answering that one). Basically the policy was (and I'm pretty sure there are laws in place about discharged patients meds and what happens to them within a time frame...) that when the patient was discharged/deceased etc the POA decided if they wanted the meds or not. They paid for them or at least the copay. They owned it essentially (I don't agree with that in the case of deceased but this was the policy the company had). If they did not want it or did not come in to pick it up within a given time frame then the medication went back to the pharmacy if the med came from our pharmacy. If it was from and outside facility, then we used a third party where we filled out a form with how many pills were being discarded and the reason. A copy went in the permanent record. Right before I quit there was a crush/dilute with water/ witnessed by two nurses/ and mixed in cat litter method with a written file as well but I never actually got to see how that one worked.

Basically it sounds like your company is skipping out on paying for uninsured patients meds by using the script that BELONGS to another patient. Can something happen to you personally in the legal sense? I'm not in the position to answer that question nor do I truly know the answer. However, what your company is doing is unethical in order to save their own money and I'm pretty sure illegal when it comes to how they obtained the medication and who they are giving it to. No pharmacy even dispensed the medication for the patient that has the new script that wasn't filled on admission. It belonged to another patient. I wouldn't feel comfortable doing this and they are asking you to do it on a daily basis which is bad.

Real cat litter?

Providing a patient with their own medications and administering medications are two very different things. Non-licensed caregivers are limited to providing patients with medications that have already been designated for that patient. Licensed/registered nurses are allowed to administer, which makes who those meds may have been intended for at one point in time irrelevant.

In medication administration, "right patient" refers to the patient on the order the nurse is interpreting. So long as the nurse is interpreting the order that is for that patient, and administering the medication stated in the order, it makes no difference if that med was in another bin, since having patient specific bins or supplies only makes it easier to locate the medication that the nurse is still going to have to evaluate based on the medication identifiers themselves (not who the med was stored for).

This typically doesn't make a difference in billing either. If what you're doing is supplying the patient with medication they supplied to facility then that would be an issue, but otherwise medicare and insurance companies are paying for each medication administered, it doesn't matter if the facility bought x amount of medications for the purpose of administering them to a certain patient, they can only bill for medication actually administered so it makes no difference to medicare or insurers who the facility intended to provide those medications to when the facility purchased them.

OP says the med cards are labeled with the name of a specific patient who has been discharged. OP also says that meds from these cards are being given to other patients.

OP also says that these other patients have insurance that does not pay for the meds, which is why these patients are given meds that were dispensed for specific, discharged patients.

It seems like a tempest in a teapot to me, frankly, but I think it's probably wrong/illegal in some way. Giving meds to Pt. A from Pt. B's cards is not sounding kosher to me.