misappropriation of prescription medications

[gooodnitenurse]

i have been working in a max security prison for almost a year now, having spent 26 years in long term care before accepting this position i am amazed by a practice in this environment that is common and accepted. when a medication is discontinued or and offender moves to another facility, their meds do not go with them but are hoarded by the nursing staff to use for transient offenders. i am so disturbed by this practice and have discussed it many times with the charge nurse and the adon superviser and they both support the practice and i have been told to "leave it alone" and " you are the only nurse that has a problem with this." I believe that just because everyone is doing it doesnt make it right or legal. at the very least this is insurance abuse. can any one tell me that this practice is legal in the correctional environment, then maybe i can let it go. this practice has given rise to other issues of medication shortages but i cannot discuss this with anyone at the workplace because i am seen as a troublemaker.

i look forward to any feed back that any one can offer on this subject.

[ocean.baby]

I have worked corrections for 24 years. I can tell you that often medications are hard to come by. There should always be a provider on call who can order the needed meds. However, if there is not a 24 hour onsite pharmacy where are you going to get the med from? Not every correctional facility is close to a pharmacy that is open after business hours. If they do open to get you a non-essential medication, it will cost a fortune. Also, most correctional facilities will not allow meds to be obtained from the local pharmacy unless they are critical meds.

Many facilities have a bubble card system where the person administering meds is to pull the tab and order meds in advance. Guess what? Many staff never do that. Maybe the inmate was supposed to see the provider to get their meds renewed and there was a lockdown; maybe the provider was sick or on vacation; maybe they ran out of time in the clinic. This means the inmate could go without medication until he/she gets in to see the provider next month. What about the new arrivals that come with medication orders but no meds? Some meds should definitely not be stopped cold turkey. What about those that really need to get their antibiotics started before the very comes next Monday?

I worked long term care as well. Our patients were with us for years, we could get new orders from the local pharmacy (in most facilities), and meds did not often change. I am not saying that the way this correctional facility handles meds is correct, it is not legal to give one person another person's prescription meds. I also know that if that is not done, many inmates would go without meds that they truly need. I have seen the best systems where they have a nurse assigned to the pharmacy and who is only responsible for ordering meds, putting them away, and making sure there is a stock supply. For facilities that have stock meds they don't have to resort to giving an inmate another inmate's meds. Many facilities still have patient specific meds - and in such large systems it just doesn't work like we wish it would. If you don't feel comfortable giving one patient another's meds, you can write NA for not available on the MAR. You should not do it if you don't feel comfortable or worry about your license. I have done both - work facilities where the medication situation was so bad that if I didn't give the inmates the meds I had available they would have gone without. I have also refused to do it and written NA. I was always lucky enough to be in a position where I could work on changing the situation, you do not seem to have that option.

["nursy", RN]

Having worked in corrections, I can tell you I did some of the same, as outlined in the above posting. However, if an inmate got transferred, I definitely sent the meds with them. Meds that got dc'd, were supposed to get sent back, but if a bubble pak has been in use, the pharmacy will throw it away, so keeping it doesn't impact anything to do with insurance. I tried to do what was the best for the patients and the facility. Was it "legal"?? No. But ethically I had no qualms.

Overall, working in corrections, I saw a lot of things that wouldn't fly anywhere else. The narcotic count logs were left blank shift after shift. We would always run out of necessary supplies that were "accidentally" left unordered, and no one would be held accountable. But I, personally, did whatever I could, to do the best job for my inmates.

[caliotter3]

While I do not agree with the practice, I can say that something similar could have been happening at any of the LTC facilities where I worked over the years. That and other inconsistencies in resident care. I find it hard to believe that you worked so long in LTC and did not develop the ability to keep yourself from getting the ‘troublemaker’ label. Not being critical, just making an observation.

[Trampledunderfoot, LPN]

Some people will call anyone a troublemaker, regardless of whether they are being one or not.

In my facility, sharing patient specific meds is avoided accept for emergent situations.

Whether it is right or not, I cannot say, but this is how it was explained to me:

The residents at the nursing home pay for their own meds, or it comes from their insurance. If you borrowed meds, you'd be stealing money from one grandma to give to another.

The meds for the inmates come out of our tax dollars. So whether I give Joe Joe's Tylenol or Bob's, it is really Tylenol that you and I paid for, so Bob should not care as long as at the end of the day, Bob still gets a Tylenol too.

In LTC I'd write NA and if it was emergent, pull what strings I had to or take from the emergency kit.

In corrections, I'm more comfortable with borrowing.

It really is up to you and what you feel comfortable with.