How would you deal with this situation re:narcotics?

[godiva]

I am new to home health, and I just started working as a case manager at a very small agency that does mostly non-skilled patients (only about 10% skilled) and ALL their patients are Medicaid. It is a family business and most of our clients are friends of the family that owns the company. Let's just say it is a very "urban" population.

Here's my situation: I am a nurse in recovery and I am a part of my state's monitoring program, so I am paranoid about narcotic issues. We have several patients where it is obvious to me that they are selling their narcotics. If they ever get caught, I would be liable in any way as an accomplice or something? My DON says that with non-skilled patients, we aren't responsible for their meds since we don't set them up and such. However, we still do medication reconciliation with the recertification visits. I do my medication reconciliation by looking at all the bottles and comparing them with our records in addition to asking the patient (because the patient doesn't always remember what has happened in two months). The other nurses just ask the patient. Using my method, I have discovered missing bottles of narcotics and bottles that were empty long before they should have been, and I don't think the patients aren't overdosing on them... they are selling them. One of our skilled patients let a drug deal go down right in front of me and I was allowed to discharge that patient, but I was chastised for informing the prescribing physician that there were narcotics missing from another non-skilled patient's home. If we start tattling on all our patients that do this, we would probably lose a lot of business, so I understand the hesitancy in being too harsh.... but I am just trying to CMA if you know what I mean!

What, in your opinion, is my responsibility as the nurse doing the recertification and assessment? Would you report that meds were found missing for a non-skilled patient?

[hottchaca]

I would report it to keep a clear conscience.As a nurse I believe I need to keep all patients safe, selling drugs can put them in harms way, think about it!

[nursynurseRN]

Find another job, if something goes Down you will be held responsible.

[SaoirseRN]

I would think reporting the discrepancies you find, particularly since you are required to to reconciliation visits, is the responsible choice. Obviously, you don't "for certain" know what happened to them (other than for the patient who made a deal in front of you), so you don't have to say how or why you think there are discrepancies, just that there are. I would report to whomever, or in whatever way your agency's policy dictates, because then it is on record that you noted and reported it. If something were to happen, you've done your part, and the fault falls on the patient. If you don't report it, you don't know what could happen. Don't take into consideration that the agency may lose business if you report, because the patients are making their own choices and your own employment should not suffer for that. I don't work in this area, and things are different in my country from yours, but I would say have a really good read over any policies your agency has regarding this, and document/report as is required.

[nursel56]

I work in home care also, so I know accounting for the use of narcotics is sketchy even when patient/client's have skilled nursing. It's also medicaid/medicare fraud, which really angers me especially in days of budget cuts when our deserving people are getting their benefits cut, and legitimate agencies end up in a crisis asking their nurses to take half-pay for 3 weeks until the state got it's act together, which happened to me. Sorry, just venting a little about this.

I see this as two issues, though. The second is that you are aware of criminal activity and not reporting it to the physician, the state, or the police. You may have a legal liability there as well. I would check with your BON and whatever mandatory reporting laws may apply to healthcare professionals. My state is very strict about that.

Your recovery and ability to retain your license are the most important things in your life. This job could put those things at risk. I know it's tough, and wish you the very best.

[itsmejuli]

If I was in your shoes I'd quit that job then I'd report the patients, the agency and the MDs for contributing to narcotic drug abuse and illegal sales.

I have a real hate on for narcotic abuse because my oldest son barely escaped with his life from opiate drug abuse.

[Not_A_Hat_Person, RN]

If they're selling narcs, especially if you're witnessing drug deals, that puts you in danger. Find another job.

[godiva]

Thanks, everyone. Unfortunately, it is the only job I could find. The DON said she will make sure I get patients that aren't abusing their narcs or patients without narcotics, so that makes me feel a little better. I don't care what the agency does so long as my name isn't on the chart as case manager. The DON is sympathetic, but the owner of the company does not want us reporting things because the vast majority of our clientele is selling their narcs for money to live on. We are so small that we can't afford to lose business.

How do you guys document things when you have similar findings? And what state are you in?

[Mom2boysRN]

Wow! Well I'm in IL. Probably most of my patients have a Rx for narcs of some sort. When we do a soc we compare their d/c med list to their pill bottles to make sure they have everything they are supposed to. If there are discrepancies we will contact the MD. As for keeping track of narcs, we don't do that. I have a med box fill that I do where the husband reported to me that the wife was taking extra Lorazepam out of the bottle rather than just taking what was in her pill box, there was no prn dosing for her. I called and reported to the MD and noted it in my visit note. I also did teaching on the dangers of taking extra. I reported it to my boss also, I wanted them to be aware since we were short a couple of times because of this. I told them they can send me to pee in a cup any time they want to.

I would have a hard time with it if I knew meds were being sold. I would ask to be removed from those cases and I would start looking for a new job stat, if I could afford to I'd just quit. Make sure you cya and be very careful, this could be dangerous for you!