Made a huge mistake now worried for career.

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I'm a new RN and have only worked in LTC for a few months. A situation happened where a resident requested a PRN drug and it was unavailable. We have been instructed not to be afraid to use our edk's and get what we need. I have never had to pulled anything from the Narc box before and was told by different ppl we had a new policy. So in short the policy was misunderstood and I didn't get prior authorization from pharmacy to pull the drug. The resident did however have an order and the pharmacy had a copy of a hard script and got the pills out later that night. I pulled the med and gave them when they were requested. My problem is I didn't get authorization for pharm and now I am concern for my job and license. The adon when I notified him stated this wasn't a med error but a very big problem and would take care of today. I didn't get a response back today everyone was unavailable or in meetings. I dont know all the rules and regulations but really am in constant worry over well my career now. I cant seem to get an answer or call back to know how this is going to be handled.

Has anyone had any similar situations or offer any input.

I don't see the big deal here. Why would you even call the pharm? To prevent diversion? Dosen't the floor staff count narcs and sign them out against residents. You had an md order and you gave the right drug. I just don't understand the problem.

I don't know the derivation of this law, all I know is that is the way it is supposed to be done.....perhaps it is considered that the nurse is dispensing w/o the pharmacist's OK?.....

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I don't get it either...and I've been a nurse for a long time. Authorization from a pharmacist to take an emergency narcotic out of the box when you already have a VALID order and you gave the RIGHT drug to the RIGHT resident????? I wouldn't worry aboout it.

I think, after reading many of these blogs about new RN grads being in LTC, that hospitals are the best place to learn and grow in nursing. I'd be really concerned about the OOD policies and lack of concern on the part of management. Just my 2 cents which means nothing.....

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Here is a quote from a Dept. of Health & Human Services communication:

Controlled substances are dispensed based upon prescriptions and not orders. These prescriptions must meet all the requirements and documentation of a prescription. There must be a separate filing system for prescriptions for Schedule II, Schedule III—V, and non-controlled drugs.

The rules have changed in LTC. In other words, even though the nursing home doctor has ordered the narcotic, the pharmacy still needs a prescription or call-in from the doc. After the pharmacy has received the script or phoned-in order from the doctor, the nurse can go ahead and pull from the E-Kit. A written order is no longer acceptable in LTC for narcs. The pharmacy needs a script.

http://www.dhss.mo.gov/BNDD/oct2010.pdf

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Thanks so much for the response, The Commuter! I learned something this morning I never knew before! I knew there was something I really liked about this site! Thanks!

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thanks for your responses. I am hoping for the best. There was a hard script on file as well. It just wasn't my day. I am really considering switching to a hospital where I learn more though and not feel so overwhelmed with 30 residents.

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Specializes in Professional Development Specialist.

We have to call for approval now too. But we have a good relationship with the pharmacy and they wouldn't make a big stink out of us forgetting once provided everything else was in order. I'm sure it will be okay. I'm sorry you're stressing out though, I hate when I spend my day off worrying about work instead of enjoying my time. I hope you can get in touch with someone at work so they can give you some peace of mind.

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UGH....this kills me. What kills me is when I reoder the med a day or so in advance, there is a valid script on file too but for some reason it isn't delivered in enough time then you have to go thru the hassle of getting into the E box for the med. Sooooooo the pt has to wait how long for a pain med (even if you anticipate the need and call pharm to see when it is being delivered and ask for it stat (2-3 hrs is stat)?????

Fight it! Don't let them right you up.

Now...if there wasn't a valid script on file....another story here.

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In the LTC the narc E-box is separate from the regular E-box. Taking stuff like cipro or phenergan from the regular box requires nothing but filling out the form and faxing it to the pharmacy for restocking.

The narc box is another animal all together. Ours has like a total of 5 lortabs and a couple of ativan. Before even thinking about opening the box, you have to call the pharmacist to get an authorization code. Then you are only allowed to take out the minimal necessary coz presumably your supply will arrive via back up delivery in a short time. I get the whole needing a code to get in the box as a way to keep better track of who and why is getting in there especially because in most facilities I have worked, nurses are waaaay to lax about accounting for meds they remove from the e-box. It never ceases to amaze me how a nurse can pull the last glucagon from the box and not notify pharmacy then when someone else is in desperate need for glucagon, there is none to be found.

The point of my rant is,,,,,we, the nurses, have not proven that we can be completely accountable for the box, which can open a door for someone looking to divert, therefore the laws that be have found it necessary to require prior authorization.

OP: I hope your situation turns out ok. This may be a good indication to the manager or DON to conduct inservice on this issue.

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It really sounds as if you didn't do anything wrong as far as good nursing care is concerned. Maybe you weren't following the policy, but it doesn't sound as though the policy is clear. You had an order for a medication that was available in your facility and you adminstered the medication. Sounds like the facility needs to make their policies clearer.

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

Don't tuck your tail and run because of one mistake. If all of us dashed for the door everytime we made a boo-boo there would be no nurses! First, if you were not oriented on the PP regarding the acquisition of meds, then it is the facility that needs a slap, not you. Secondly, if there was an order, the pharmacy had a hard copy of the prescription and your only "sin" was that the pharmacist didn't call you and say "absolutely give the med", then you cannot be held for diversion. You were acting in your resident's best interest and believe me the penality for a resident in pain who does not get their medications timely is far worse for the facility than a nurse who didn't get proper orientation, and essentially did not follow PP but acted in the residents best interest. They can write you up, but I would ask when the orientation was given on this "new" PP and where is it documented that you attended this inservice and signed/documented that you were aware of the changes. I know you are upset. It is scary to think that you have done something wrong. The ADON probably said that to you because he/she was not sure what to do about it and had to check with someone else. I would call the DON/ADON and ask to come in and talk about it. I would also be prepared to ask the questions about the orientation and new PP and also remind them that your residents confort and well being were your first priority and that with training on the new procedure you can assure them this would not happen again.

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I'm a little confused...I may have skimmed right over it, but was this a new order for a narc or the patient just ran out of a narc that was already prescribed? If it was an order already in place, I would have absolutely given the med out of the E-kit.

I work in LTC and we don't get admits on 3rd, we also have a rinky dinky pharmacy that has bankers hours. So, if a new admit comes at say 5:30, pharmacy has to make a special trip to make sure the meds are delivered. We are ALWAYS running out of meds and it drives me BONKERS!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I've never ever heard of having to call the pharmacy first for approval before taking a med out of the emergency box. :confused: I've been in nursing for 37 years.

LTC regulations are different then Acute care and are different in every state. It still sounds like a policy issue and not DEA/federal mandate. Relax....you had an order for the narcotic so your license is ok. Call you manager and ask for the policy and if you can stop by to get it......if you have call them they will answer any legal questions or regulatory questions. If you don't have malpractice....get it...it is a good safeguard......then call your nursing board to see what the long term regulations are....use this as a learning experience. calm down you should be just fine! :heartbeat

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