giving meds with other name on them

[nurseat52]

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

[AdamantiteEnigma]

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]

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.

[eukaryote]

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).

[Kooky Korky, BSN, RN]

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.

[Kooky Korky, BSN, RN]

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?

[Kooky Korky, BSN, RN]

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.

[Jules A, MSN]

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.

Definitely don't attach your name to any complaints about this issue. It is shady and I would imagine results in a significant amount of money being "saved". You don't want to be anywhere near this stinky pile, imo.

[BloomNurseRN, ASN, BSN, RN]

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. ???

Right patient, right med, right route, right dose, right time (and right documentation) would be the 6. You put right day and right time, which are essentially the same. 😊