medication mismanagement?

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Hello All,

This is my very first post! I visit this site often, but have never posted. My situation is this: I worked on a Med/Surg floor at a small hospital. I was assigned to a wound patient that needed a dressing change and orders to pre-medicate before dressing change. His order was for (2) 5/325 hydrocodone. The omni was out of 5/325's so I gave him (1) 10/650 instead. I was fired for medication mismanagement. I have since talked to a few pharmacists that have said this is a perfectly appropriate substitution. Any thought?

Specializes in Neuro ICU and Med Surg.

I agree with Sapphire18.

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Specializes in Emergency, Telemetry, Transplant.

Personally, I think it is a totally reasonable "substitution." However, I am not an administrator of the facility and this was a narc. Even so, I think firing the nurse was over the top.

My guess--there is more to the story.

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There actually is more to the story. In 2003 I hurt my back at work and quickly became dependent of opiates, which led to diversion. After about 3 months I turned myself in to my DON. I voluntarily surrendered my license, completed rehab and was on probation for a year (as well as submitting to random drug testing). I was advised to take a few years off from nursing. I went in to medical sales for about 5 years and, even though the money was great, I missed nursing. During the time that I was in sales I went back to school to become a WOCN. When I interviewed for the postion that I was just fired from, I was totally honest about my past. The CEO told me she would give me a second change. For 2 years, there was not a single problem. I ran my own wound clinic and was very successful at it. When this incident happened with the substitution the CEO told me I blew my second change. The CEO also turned me in to the board of nursing. I have a hearing coming up soon and am just trying to get others' perspective on the situation.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

every facility has their own policies and regulations.....AND interpretation of the regulations. If this was a no no at this facility then it'a a no no. I have found smaller facilities much more anal...I mean literal...about these types of things. If this was during the day.....a call to pharmacy would have been the thing to do.....a call to the doc...hey can I do this until we get the 5mgms in? Even if it is stupid it is clearly better to be safe than sorry.

While it is the same dosage it is not the same order....however I don't feel that is an offense IF this was a one time singular error....but again most facilities disciplinary actions are up to and including termination ....if your manager was told to decrease FTE's (personnel) the best way to do that without having to pay unemployment is to fire someone for a clear cut offense. (even though that doesn't really mean anything...and apply anyhow) Or there is more to the story

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
There actually is more to the story. In 2003 I hurt my back at work and quickly became dependent of opiates, which led to diversion. After about 3 months I turned myself in to my DON. I voluntarily surrendered my license, completed rehab and was on probation for a year (as well as submitting to random drug testing). I was advised to take a few years off from nursing. I went in to medical sales for about 5 years and, even though the money was great, I missed nursing. During the time that I was in sales I went back to school to become a WOCN. When I interviewed for the position that I was just fired from, I was totally honest about my past. The CEO told me she would give me a second chance. For 2 years, there was not a single problem. I ran my own wound clinic and was very successful at it. When this incident happened with the substitution the CEO told me I blew my second chance. The CEO also turned me in to the board of nursing. I have a hearing coming up soon and am just trying to get others' perspective on the situation.
I'm so sorry....((HUGS)) that really stinks.....do you have ....don't go to the board alone.
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Reviewing the OP's problem just makes me think the dumbing down of nursing is not only ongoing, but getting worse by the minute.

If someone can be fired because she gave the EXACT correct dosage of EXACTLY the correct medication at the correct time to the correct person (and yes, it was oral and not anal or something equally stupid), then I don't know what this profession is coming to. Seriously.

While I have little to no sympathy for those who divert meds from patients to themselves, I don't suffer administration's stupidity lightly either. And this reeks of it. UNLESS there is yet MORE to the story.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Reviewing the OP's problem just makes me think the dumbing down of nursing is not only ongoing, but getting worse by the minute.

If someone can be fired because she gave the EXACT correct dosage of EXACTLY the correct medication at the correct time to the correct person (and yes, it was oral and not anal or something equally stupid), then I don't know what this profession is coming to. Seriously.

While I have little to no sympathy for those who divert meds from patients to themselves, I don't suffer administration's stupidity lightly either. And this reeks of it. UNLESS there is yet MORE to the story.

I've been talking aobut the dumbing down of nursing for a while.....where will it all end up???? :no:

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I've been talking aobut the dumbing down of nursing for a while.....where will it all end up???? :no:

When we cannot be allowed to clean an incontinent patient without a doctor's order: "Remove feces from patient's skin surfaces q shift and prn".

Please.

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Two 5/325 hyrdocodones = one 10/650 hydrocodone. No error.

I can't help but think that there is more to this story...

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Specializes in Emergency.
Reviewing the OP's problem just makes me think the dumbing down of nursing is not only ongoing, but getting worse by the minute.

If someone can be fired because she gave the EXACT correct dosage of EXACTLY the correct medication at the correct time to the correct person (and yes, it was oral and not anal or something equally stupid), then I don't know what this profession is coming to. Seriously.

While I have little to no sympathy for those who divert meds from patients to themselves, I don't suffer administration's stupidity lightly either. And this reeks of it. UNLESS there is yet MORE to the story.

Love this...^^

For a second I was thinking "did the pt expect one pill so take 2 tabs out and divert one, patient gets a half dose... Is this what the manager was thinking happened?" But then I re-read the post and realized it was the opposite, and then did a facepalm.

The math level required to figure out that 2 tabs of 5/325=10/650 is taught in primary school. At my facility this is a no-brainer, not only would I give 2 pills instead of one, I would, and do, happily split a pill (gasp) if it is appropriate to do so. I really cannot believe some of the reasons I see for people getting fired on this forum.

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In my ICU we frequently modify orders in the computer to suit our needs. If it were me I would have changed the order, taken out the 10/650, given it and then let pharmacy (we have our own satellite pharmacy on the unit) and the resident know after the fact. No harm no foul. I don't know that I could work in an environment like the one you are describing. I have to think something else happened or happened in the past.

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We frequently ran out of 2mg morphine vials and would give 2mg from a 4mg vial. The medication would be overridden in the Omni and we'd witness the waste. It would scan wrong on the it's med admin screen and we'd write a note as to why and continue with the override. This is the same, in my opinion, as what the OP is saying. If my order is for 4mg of morphine and I use 2 2mg vials or 1 4mg vials, there's no difference.

Unless there's more to the story, I can't understand why anyone would be fired for the OPs reasons. I suppose you could call the MD to clarify giving the one pill instead of 2. I'd get chewed out if I called the doctors to ask if it's ok to use 1 4mg vial instead of 2 2mg vials just because the Omni ran out.

If we had no way to substitute, we'd call pharmacy and go get the med.

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