My pt accused my coworker of taking her Percocets! (long)

[shoegalRN, RN]

Ok, here's the story. I just need a different set of eyes and point of views regarding this issue.

I work nights and I am a new grad. I am in a new grad residency program and in orientation in the SICU. I was assigned two pts, one of the pts I had the previous night.

This particular pt is something else. First off, she has a hx of IV drug use and was in the ICU d/t a kidney biospy. She was a transfer from the floor. She argued with my preceptor and I most of the night over the "pain management". According to notes from the floor, she will go to the bathroom for about "30 minutes" and then come out with a small bag full of syringes that was not given at the hospital. This pt also has several bruising and needle marks on her lower legs bilaterally that she claims another facility caused by attempting IV starts.

Well, this night I got the pt, I got report from the day nurse who said an order was entered to change her Percocet to 15 mgs PRN q 6 h. He gave her the 15 mg of Percocet at approximately 1600. She was also SCHEDULED for Oxycontin 80 mg at 2100. Well, it was about 2030, and I was getting ready to get her scheduled oxycontin out of the pysis. We have an hour before and after schedule med is due to give the med. I wanted to be somewhat ahead of schedule just in case something happened (ie other pt crashing).

I go to the med room to get the oxycontin. There was another nurse in there at the time. I pulled up my pt's name and her med profile and her oxycontin was grayed out. I asked the other nurse what that meant and she said I would have to go to another pysis to get the oxycontin. I said ok and exited out. As I was on my way to the other pysis, my other patient started crashing. I ran into the room and my preceptor was already there. The other nurse asked me if I wanted her to get the oxycontin for my other patient, I said yes as I'm trying to get oxygen on my crashing patient.

Fastforward to an hour later, I go into my other pt's room and she asked me for her 15 mg of Percocet. I look at the MAR and the nurse who gave her the 80 mg of Oxycontin charted that she also gave her the 15 mg of Percocet AT THE SAME TIME! I advised the patient of this. The pt stated "I never seen that nurse before in my life and she came in her and gave me my 80 mg of Oxycontin, the green pill. She never gave me the 15 mg of Percocet, which are white pills and it would have been 3 of them. She only gave me one pill".

So, I told my preceptor what happened. We checked the pysis and sure enough, the Percocet and Oxycontin were pulled out at the same time under my co-worker's ID. The patient states she knew she couldnt have her Percocet until after 2100, and she would have asked for it. The pt also states the nurse did not have a med cup, she opened the 80 mg of Oxycontin and gave it to her in her hand. My first reaction was to check the trash for open wrappers, but the housekeeping lady had already dumped the trash.

My preceptor went to the other nurse and asked her what happened. It was a totally different story. The other nurse said that she gave all 4 pills to the patient and asked for her pain score which the pt replied it was a 9/10. The preceptor had no choice but to go to the nurse manager because the pt started throwing a fit about the Percocet not being given. The nurse manager interviewed the pt, who told her the same thing she told me.

We had to call the pt's doctor and advise him of what happened, and then override the Percocet and give it to the pt. I gave it and then keep the wrappers for myself. I charted that I gave them and made sure my preceptor was in the room at the time.

I was also interviewed by the nurse manager and I had to send something in writing about this whole incident. So did my preceptor. The nurse involved also had to take a drug test. I don't know who to believe. I feel so bad because it was my patient. What do you all think? I'm only hoping the patient was proven to be a liar. Is that wrong?

[Reno1978, BSN, RN]

Well, given the patient's history and behavior, it could very well be that she was lying.

However, it wouldn't be the first time a nurse diverted drugs.

Let us know how it pans out!

[tobeyorrlpn]

Ok, here's the story. I just need a different set of eyes and point of views regarding this issue.

I work nights and I am a new grad. I am in a new grad residency program and in orientation in the SICU. I was assigned two pts, one of the pts I had the previous night.

This particular pt is something else. First off, she has a hx of IV drug use and was in the ICU d/t a kidney biospy. She was a transfer from the floor. She argued with my preceptor and I most of the night over the "pain management". According to notes from the floor, she will go to the bathroom for about "30 minutes" and then come out with a small bag full of syringes that was not given at the hospital. This pt also has several bruising and needle marks on her lower legs bilaterally that she claims another facility caused by attempting IV starts.

Well, this night I got the pt, I got report from the day nurse who said an order was entered to change her Percocet to 15 mgs PRN q 6 h. He gave her the 15 mg of Percocet at approximately 1600. She was also SCHEDULED for Oxycontin 80 mg at 2100. Well, it was about 2030, and I was getting ready to get her scheduled oxycontin out of the pysis. We have an hour before and after schedule med is due to give the med. I wanted to be somewhat ahead of schedule just in case something happened (ie other pt crashing).

I go to the med room to get the oxycontin. There was another nurse in there at the time. I pulled up my pt's name and her med profile and her oxycontin was grayed out. I asked the other nurse what that meant and she said I would have to go to another pysis to get the oxycontin. I said ok and exited out. As I was on my way to the other pysis, my other patient started crashing. I ran into the room and my preceptor was already there. The other nurse asked me if I wanted her to get the oxycontin for my other patient, I said yes as I'm trying to get oxygen on my crashing patient.

Fastforward to an hour later, I go into my other pt's room and she asked me for her 15 mg of Percocet. I look at the MAR and the nurse who gave her the 80 mg of Oxycontin charted that she also gave her the 15 mg of Percocet AT THE SAME TIME! I advised the patient of this. The pt stated "I never seen that nurse before in my life and she came in her and gave me my 80 mg of Oxycontin, the green pill. She never gave me the 15 mg of Percocet, which are white pills and it would have been 3 of them. She only gave me one pill".

So, I told my preceptor what happened. We checked the pysis and sure enough, the Percocet and Oxycontin were pulled out at the same time under my co-worker's ID. The patient states she knew she couldnt have her Percocet until after 2100, and she would have asked for it. The pt also states the nurse did not have a med cup, she opened the 80 mg of Oxycontin and gave it to her in her hand. My first reaction was to check the trash for open wrappers, but the housekeeping lady had already dumped the trash.

My preceptor went to the other nurse and asked her what happened. It was a totally different story. The other nurse said that she gave all 4 pills to the patient and asked for her pain score which the pt replied it was a 9/10. The preceptor had no choice but to go to the nurse manager because the pt started throwing a fit about the Percocet not being given. The nurse manager interviewed the pt, who told her the same thing she told me.

We had to call the pt's doctor and advise him of what happened, and then override the Percocet and give it to the pt. I gave it and then keep the wrappers for myself. I charted that I gave them and made sure my preceptor was in the room at the time.

I was also interviewed by the nurse manager and I had to send something in writing about this whole incident. So did my preceptor. The nurse involved also had to take a drug test. I don't know who to believe. I feel so bad because it was my patient. What do you all think? I'm only hoping the patient was proven to be a liar. Is that wrong?

hey this kind of issue really touches home with me.someone i dearly love has a hx of addiction,ya know there will always be narc seekers,but wat if ur pt was tellin the truth?of course theres always a chance thats she just tryin to get as much narcs as she can but we( Healthcare professionals) all tend to assume the obvious,those with drug abuse hx are to be doubted.but they would be the prime target to steal meds from right?We all no that nurses as well as dr.s lawyers and any other professional is just as capable of addiction as anyone else.So again who would be a better canidate to take meds from other than a previous documented addict??oh and just because she was required to take a drud test doesnt mean your coworker didnt steal the percs,did u know that if she has a legal rx from her md for oxycodone and she tests positive the md reading the test results has to legally say that there were no unpresribed rx in her system.id love to know wat came of this situation.----keep me posted thanx

[tobeyorrlpn]

Hey let me know about the out come of your coworker vs patient rx hx. Also, what did you think about my comment to your story:yeah:

[shoegalRN, RN]

Hey let me know about the out come of your coworker vs patient rx hx. Also, what did you think about my comment to your story

Thanks for your comment! I will say that the coworker is a float nurse. I have seen her around the hospital in the ER, in MICU, and on the floors.

A couple of things strike odd to me regarding the coworker:

-She OFFERED to get the Oxycontin at a bad time (i.e pt crashing) instead of running into the room like everyone else. That was odd to me, because a pt's schedule pain med is NOT the priority. However, SOA is.

-I said NOTHING about the PRN oxycodone to her, so I have no idea why she would take it upon herself to look at the pt's PRN's and removed them.

-Not to mention, it was not time for the oxycodone to be given, although it was PRN.

-The nurse made a long note in the chart about me being tied up with a crashing pt and she was helping out by giving the pt her Oxycontin and oxycodone.

-I found it rather strange to give a pt 80 mg of Oxycontin AND 15 mg of Oxycodone at the SAME time! She knew nothing about my pt. I would be afraid I would snow the pt out by giving both meds at the same times in such high dosages.

I also thought about if the coworker tested positive for oxycodone, she could say she had a scipt for it. Also, after this whole entire incident, coworker was off the unit for about 30 minutes, took forever for nurse manager to find her.

One thing I notice about pts who have schedule narcs and PRN narcs is they KNOW how many mg's they should be getting, when it's time for it, when the last time they got it, and what the pill looks like. This pt fit that descripition.

I really want to believe that my coworker is not diverting. I really do. Therefore, I'm a little bias, but I can't ingnore the facts.

[SuesquatchRN, BSN, RN]

Patient wanted a double dose.

[shoegalRN, RN]

Patient wanted a double dose.

I thought about that too, given the drug hx of this pt and all the strange activity she was doing on the floor.

Also, I forgot to mention, this pt wanted to be unhooked from the monitor so she can go outside and "smoke". She was told no several times by myself, my preceptor, and the doctor. She pulled this stunt up on the floor and would unhook herself from her fluids and leave anyway.

She threatened to leave AMA several times during my shift the first time I had her. Then she tries this.

The second night I had her, she was caught smoking in her room in the ICU! They took her cigarettes and she again was threatening to leave AMA. Then this happened on my shift.

[SuesquatchRN, BSN, RN]

I'm supporting my sister nurse unless there is absolute proof she was lying.

She knew the patient wouldn't be snowed, and that she'd want it all.

[canoehead, BSN, RN]

The patient is not to be trusted, based on her history.

When a patient crashes someone has to keep track of the rest of the floor, so offering to help makes sense. Giving oxycodone and contin when only one is due doesn't make sense.

Even funnier is disappearing for 30 minutes. Was she on a planned break? Did she sign out to a covering nurse?

In this type of situation I am grateful that the investigation and decisions are being made above my pay level. I would be careful wasting with this RN, and be frank that you "need to protect each other, and be extra sure."

I'm sure it will all shake out, but what an uncomfortable situation.

[canoehead, BSN, RN]

Also, I forgot to mention, this pt wanted to be unhooked from the monitor so she can go outside and "smoke". She was told no several times by myself, my preceptor, and the doctor. She pulled this stunt up on the floor and would unhook herself from her fluids and leave anyway.

Try that ONCE and I call the doc and plan to have the patient discharged if she leaves again, and tell her so. Strip the room, and call security too, so she knows you mean it. Some docs won't do it, but as a nurse you can do mouth checks after giving pills, and crush the instant relief meds so they are harder to hide. Get a sitter to follow her around (even to the bathroom).Ask for a tox screen too, and you'll know if she's been supplementing the meds you give her.

[shoegalRN, RN]

Try that ONCE and I call the doc and plan to have the patient discharged if she leaves again, and tell her so. Strip the room, and call security too, so she knows you mean it. Some docs won't do it, but as a nurse you can do mouth checks after giving pills, and crush the instant relief meds so they are harder to hide. Get a sitter to follow her around (even to the bathroom).Ask for a tox screen too, and you'll know if she's been supplementing the meds you give her.

I asked my preceptor the first night should we get a sitter because she was on strict bedrest due to a hemoglobin of 7. She was getting PRBC's and wanted to unhook herself from her blood to go and "smoke". We found her on the "floor" using the bedpan and ordered her back to bed due to her GI bleed. This is when I suggested a sitter because she also turned off her IV pump when it started beeping that infusion was done, although it was still some fluid to be infused. I turned the pump back on and told her not to touch the pump, I will do that. These were things she was doing on the floor and got away with.

[Nurse1966]

Wow, tough situation. On the one side, I'm with Suesquatch...the RN knew the pt could tolerate that much narcs at one time, and I wouldn't want to through a fellow RN under the bus, if she's innocent. On the flip side, an addict knows exactly what pills to expect and when to expect them, and if this nurse is diverting, the best thing to happen to her is to get caught and get help.