A couple of weeks ago, our facility had some narcotic syringes missing from our med cart. This happened on a weekend that I do not work. I was frantic because I knew that I had counted these syringes correctly with the oncoming staff. I was not called or notified that weekend of this. Found out when I reported to work the following week. I am in the Admin office wanting to know if police called, drug testing and trying to get to the bottom of what happened. So come to find out, this is what happened, (after I stated I was going to call police to file a report). The Admin stated that another CMA wanted to "teach" the other CMA's a lesson the importance of counting the narcotic syringes. He/she had taken the narcs out of the locked med box and had given them to the Admin, so the narcs would be "missing". He/she in turn had them in his/her desk drawer and not locked up. He/she showed me that he/she had the missing syringes and he/she left them on him/her desk for at least a week. We kept telling him/her to put these up or waste them, (with witnesses),
due to the fact that many people are in and out of his/her office all the time. Kept telling Admin that syringes could be used and returned to the desk top.
So guess what? Came to work and the syringes are back in the locked narc box and signed off by the CMA that originally took them out! How in the world do I know that the medication is actually in the syringes? I keep signing off the narc count sheet as incorrect d/t to the fact they were missing and now returned. The staff confronted the Admin regarding this and we were told the CMA's needed to be "taught" a lesson by this other CMA. Informed him/her that he/she had put our nursing licenses on the line with this stunt. We were told this action was never directed towards the nurses...huh?
Where do I go from here (besides out the door)? Oh, one other thing...this certain CMA is the "best buddy" of the Admin. and loves to keep the facility "stirred" up to their advantage.
no specific standards exist re assisted living facilities or snf's; however, think that standards applying to home health agency would be similarly applied to alf:
535:15-15-2. pharmacy agreements with home care agencies (hca's)
(a) pharmacies will be allowed to place certain drugs with hca's for the betterment of public health.
(b) the pharmacy shall remain the legal owner of the drugs.
drugs by authorized employees and shall be approved by the pharmacy manager.
(d) the pharmacy manager shall review the protocol to assure safe, secure and accountable handling of the dangerous drugs is
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maintained under the protocol. the protocol should stress the use of these drugs should not be for routine use, but for
emergency use and the need of the patient.
(e) the pharmacy manager or a designated pharmacist shall physically inspect and review the drug storage and handling at the
hca at a minimum of every four months.
[source: added at 12 ok reg. 2593, eff. 6-26-95; amended at 13 ok reg. 2807, eff. 6-27-96; amended at 14 ok reg. 3024]
535:15-15-3. home care agency protocol
home care agency protocol will include, but not be limited to, the following:
(1) safe and secure storage of drugs;
(2) access to drugs limited to authorized employees;
(3) records of drugs checked out to authorized employees and records of drugs, amounts, to whom and by whom
administered;
(4) prompt notification of the pharmacy when a drug is used, including the prescriber, patient, drug, dosage form,
directions for use, etc.;
(5) billing information;
(6) procedures for handling drugs beyond expiration date (outdated drugs shall be returned to the pharmacy,
quarantined and destroyed in a reasonable time frame); and,
(7) inventory control.
[source: added at 12 ok reg. 2593, eff. 6-26-95; amended at 13 ok reg. 2807, eff. 6-27-96]
this type event outside most rns and don training and requires prompt handeling and reporting up the chain of command.
1. corporate office needs to have verbal and written notification.
2. pharmacy supplier needs to be notified to provide inventory and testing of "returned" drugs along with entire present supply of narcotics and issue new stock.
cost of this should be borne upon facility ---passed onto administrators budget.
3. notification to state licensing authority --better to report than to have anonymous investigation or found on inspection.
many other states do not permit cma's to handle stock/patients individual narcotic meds. way this admin went about it opened up far greater legal issues. a don could have set up similar activity with pharmacy removing meds and providing immediate inservice next day when count not correct as corrective action plan for facility when suspecting that cma's not following established procedure for narcotic count.
Thanks so much for your input. I had already decided to contact our corporate office on Monday, then our pharmacy, and finally the state. I also will be notifying the Admin, that since I have no idea what syringes were returned to the narc box, that I will not be giving this resi the medication. Luckily, the med is a PRN and has not been used since March.
I am so thoroughly disgusted with this matter, that I plan on giving my notice. This has been an absolute nightmare for me and my fellow nurses. What a low life stunt to pull to "teach" the CMA's a lesson. Unfortunately, their "lesson plan" is going to backfire on them. I wish them well...
This should be immediately reported to your state board of nursing! Immediately. I cannot express enough the urgency here. Your license is actively on the line...The statute of limitations for prosecution for something like this is well over 12months. Give them a call on their hotline NOW! The longer you wait the worse this will be for all parties involved. This is completely unacceptable behavior by any HCP.
I appreciate your support and to all that have written. What a sad way to leave a job where I really enjoy my residents and fellow coworkers. They are the best and in the same boat...
I just can't believe anyone could be so utterly stupid to "teach" a lesson to my peers.
Well, I have a question? Why are narcotics wasted? Why with the raising cost of meds can't they be recycled? Why do the laws require such expensive drugs to be wasted? Wasted? Why should we waste anything? This to me seems like the drug industry is no different than the insurance industry. There is nothing wrong with the drugs that are wasted is there? Please let me know. I think the healthcare workers need to come together and instead of wasting good drugs give them to the ones who can't afford. I think the lawmakers are protecting the drug industry by making nurses waste the most expensive thing available. What is up with that?
NRSKarenRN, BSN, RN
10 Articles; 19,179 Posts
link to: oklahoma pharmacy lawbook
this type event outside most rns and don training and requires prompt handeling and reporting up the chain of command.
1. corporate office needs to have verbal and written notification.
2. pharmacy supplier needs to be notified to provide inventory and testing of "returned" drugs along with entire present supply of narcotics and issue new stock.
cost of this should be borne upon facility ---passed onto administrators budget.
3. notification to state licensing authority --better to report than to have anonymous investigation or found on inspection.
many other states do not permit cma's to handle stock/patients individual narcotic meds. way this admin went about it opened up far greater legal issues. a don could have set up similar activity with pharmacy removing meds and providing immediate inservice next day when count not correct as corrective action plan for facility when suspecting that cma's not following established procedure for narcotic count.
at least, reprimand on administrators file.