Honesty IS The Best Policy.

Cherish · Mar 30, 2007

I wouldn't have covered anything up. When you do something like that it always comes back to bite you in the bum. I am not an RN so can't tell you if what you did is right or wrong, but ethically I think you did the right thing.

dekatn · Mar 30, 2007

I can't imagine a narcotic drug like xanax not locked, wouldn't you have to do a narc count on it just like all other narcs? Do you have to sign it out like other narcs? You did the right thing, but I would check into why this medication isn't locked and counted along with other narcs.

ginger58, ASN, RN · Mar 31, 2007

Xanax isn't a narcotic.

Schedule IV Narcotics or non-narcotics

(a) The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule III.

(b) The drug or other substance has a currently accepted medical use in treatment in the United States.

dekatn · Mar 31, 2007

oops, Ginger58, you are right. We keep xanax, diazepam, lorazepam locked with narcs and other drugs that have a high potential for abuse.

gonzo1, ASN, RN · Mar 31, 2007

you absolutely did the right thing notifying charge about these missing meds. An incident report or what ever paper work your facility requires should be done too. Xanax is a med that should be under lock and key and has potential for abuse. Hope it doesn't go missing again.

I have found that honesty is always the best policy

banditrn · Mar 31, 2007

I've never gotten a satisfactory answer why they don't lock the Xanax up at this facility - the card has the big red C indicating it's a controlled substance - and it was locked up at the other facility where I worked.

And, I believe it was always a lock-up drug at the hospital. I THINK their rationale is that it's in a locked med cart.

The thing is that I don't know if when the gals take the cart out with them on days and evenings if they lock the cart when they leave it. BUT the way those cards are stuffed in there, a person would almost have to know it was there - it would be too hard to just by chance remove the one card with Xanax on it, quickly, before anyone noticed.

Daytonite, BSN, RN · Apr 1, 2007

our personal ethics sometimes play a number in our minds when something like this happens when you find problems with drugs. you did the right thing to report the missing card of xanax. the don was also right in starting an investigation to determine what might have happened to it. it's not your fault if the don can't be discrete and tactful in her methods of questioning.

i've seen nurses who are very nonchalant about not locking up their medication carts when leaving them standing in the halls. that can make them easy targets for anyone who has larceny on their mind. patient safety is also at issue. we had a patient in one facility who was able to get into the back section of a medication cart which one nurse consistently left unlocked because she had difficulty figuring out which key opened it. :uhoh3: the oversized bottles of medications were stored back there. the patient, bent on committing suicide, opened the unattended cart, took the largest bottle of pills she could find, went back to her room and proceeded to take every pill in the bottle. when nothing happened after a few hours, she reported what she had done to the nursing assistants who told the don. the patient was sent to the er for evaluation, a big incident report done and the nurse was fired since she had been warned about keeping her cart locked when leaving it in the hallways before.

something that i didn't see anyone else mention is that when these missing drugs have to be replaced, whoever is paying for them (the patient or their insurance coverage) ultimately ends up buying the replacement drugs. that's not fair. if someone did steal the card of xanax then they stole from the patient. they will realize that their theft was noticed immediately and, hopefully, won't be too quick to do that again. it's quite possible, i suppose, that the card will turn up as having gotten caught and trapped somewhere between the drawer and the inside of the cart itself. i've seen that happen before, too.

ktwlpn, LPN · Apr 2, 2007

I've never gotten a satisfactory answer why they don't lock the Xanax up at this facility - the card has the big red C indicating it's a controlled substance - and it was locked up at the other facility where I worked.
And, I believe it was always a lock-up drug at the hospital. I THINK their rationale is that it's in a locked med cart.
The thing is that I don't know if when the gals take the cart out with them on days and evenings if they lock the cart when they leave it. BUT the way those cards are stuffed in there, a person would almost have to know it was there - it would be too hard to just by chance remove the one card with Xanax on it, quickly, before anyone noticed.

It's only been in the last 3 or 4 years that we started locking and counting those drugs.I was glad when we started doing it because too much stuff was going missing and the system protects us...A resident died and no-one documented disposing of her meds-2 nurses were diverting and both lost their jobs.It never would have happened if we were securing the meds properly....

CapeCodMermaid, RN · Apr 2, 2007

We've always locked up Xanax in Massachusetts. Two facilities I worked at had us locking up Ultram because of the high incidence of abuse. I can't tell a lie, either. Fess up and take the consequences. The nurses used to make fun of the way I did narcotic count. Imagine, I actually paid attention and looked at both the book and the card. Lots of them hardly looked at all and then wondered why count was off 8 hours later. If you've ever been in a building where the feds walked in because of suspicion of drug diversion, you would never have such a nonchalant attitude towards locked up meds.

banditrn · Apr 3, 2007

We've always locked up Xanax in Massachusetts. Two facilities I worked at had us locking up Ultram because of the high incidence of abuse. I can't tell a lie, either. Fess up and take the consequences. The nurses used to make fun of the way I did narcotic count. Imagine, I actually paid attention and looked at both the book and the card. Lots of them hardly looked at all and then wondered why count was off 8 hours later. If you've ever been in a building where the feds walked in because of suspicion of drug diversion, you would never have such a nonchalant attitude towards locked up meds.

Capecod - I came from working in the hospital, where just ONE missing pill could be cause for 2 hours of headache until it was accounted for - and they wonder why I get hysterical.

In the last LTC facility - the one where I quit, if a narc was missing, they'd just leave a blank line in the narc book. This male nurse and I almost had a throw down over that policy, when I found out it was him that wasn't charting his narcs - he called me a 'damned uptight ICU nurse'! I just reported his hiney to the DON and told her I thought they needed to be a little more responsible.

SuesquatchRN, BSN, RN · Apr 3, 2007

I sure would have reported that card. NYS is very strict, and suspicion of diversion is one cloud I don't need over my head.

Only our DON orders controlled substances, except for refills.