I would like your opinion in this matter that happened to a friend of mine recently who is a LPN. Disciplinary action was metered out to her and her employment terminated because she was acused of diverting narcotics, but not for personal use.
All the web searching about narcotic diversion related to diverting for personal use. According to my friend she was working on a very heavy sub acute unit and the normal procedure for ordering stat medication for new admissions who havent yet received their medication from the pharmacy was to generate a one time order so that one can be taken from the Emergency box in the nursing office and that order is used to fax to the pharmacy so they can replenish that pill taken from the e-box.
Whilst on the unit she was in the process of processing the admission orders for 3 new admissions on her shift and 1 new admission that came in 30 min prior her shift begining at 3pm. While imputing the orders for the admissions she saw 3 residents in a verbal dispute 2 of them are mentally alert and were confronting the third who is not mentally alert to time, person or place. The third who is in a wheelchair because she was not able to bear her weight and prone to falls attempted to stand from the wheelchair while attatched to a lap belt, she also attempted to push the wheelchair backwards when the brake was initiated and her chair doesnt have anti-tippers attatched and may fall head first backwards in the wheelchair. The nurse upon seeing what was going on and what can happen, stopped what she was doing to quell the situation and prevent a potential incident. The nurse whilest in the process of removing the third resident was confronted by the nursing supervisor on duty and was told that mr. X was ringing the call bell for the past 30 min asking for a pain medication. The nurse not being able to immediately go to the nursing office to get a pill from the e-box gave mr. X a narcotic pain med which is ordered for him btw same dose same everything (hes one of the new admission) from another resident blister pack , mr. Y ,who was due in 30 min. The nurse generated a one time stat order for mr. X to replace that pill taken from mr. Y to give to mr. Y in 30 min. since hes is on a standing order every 8 hrs. The nurse while in the process of now getting that pill to replace the one given told the nurse supervisor what she did and the nurse supervisor said that she diverted narcotics and disciplinary action had to be taken against her. This ultimately lead to her being terminated....aka asked to resign in lieu of termination for narcotic diversion-not to self but to another resident for which the same medication is ordered. Not to mention that the resident who was given the pill initially refused it asking for an injectable. My friend said that she had to do some 'patient teaching' that his purpose in a sub acure rehab is to gradually be weaned off the heavy formulation that is used in hospitals and acute care settings. This eventually led to him accepting the medication and then told that its every 4 hr so he is entitled to another in 4 hrs for breakthrough pain and in 2 hrs tylenol could be given as per doctors orders.
My friend now feels that nursing is a thankless job and that its like saving somone from burning building only to save them and you yourself die. All parties in the scenario live to see another day and be pain free and the nurse is the one left to bite the bullet. Not to mention that on that day she completed the admission orders for 3 new admissions and did 16 hrs while doing her job for 55 residents on a sub acute / long term care unit.
Nursing is more paper than people, you spend more time writing to cover your ass than take care of people. Not to mention that everyone wants to sue your ass and the very people you are taking care off think of you as their personal butler. And each of them want you to be there at their beck and call as soon as the call bell goes off.
Don't get too involved with "friend's" business. This may not have been her "first" time with questionable narcotic borrowing. OR, the DON just doesn't like her. Another yucky fact of nursing. Just know, this is a cut throat business no matter how altruistic some of us may be. RNs and LPNs are moving targets. Yuck.
Don't get too involved with "friend's" business. This may not have been her "first" time with questionable narcotic borrowing. OR, the DON just doesn't like her. Another yucky fact of nursing. Just know, this is a cut throat business no matter how altruistic some of us may be. RNs and LPNs are moving targets. Yuck.
You really do have a very, very thorough and detailed understanding of what happened to your friend. I think that even if something like that had happened specifically to me, I wouldn't be able to remember all the details with such precision, detail, and accuracy.
Is this really about a friend? Or is it a hypothetical presentaton of a situation for some other reason? For example, homework?
that is not narcotic diversion. that is called "borrowing". i know we are not supposed to "borrow" but if you go to the pyxis for every single med that is not there, you'll be passing meds all day. this is the reality of ltc. i personally would not "borrow" narcotic because it is counted and needs to be accounted for.
your friend was being resourceful but got burned. why was she terminated right away? no warning or suspension first?
eta: in my per diem job, borrowing narcotic is even allowed by the don. you just put the patient's name on somebody's narcotic sheet and sign. i cannot do that in my full-time job because the don does not allow it.
"borrowing" of a prescription drug is diversion no matter the reason or drug and is against the law.
have you ever read the little disclaimer on ever prescription drug label?
federal law prohibts the transfer of this drug to any person other than the patient for whom it was prescribed
the don allowing it doesn't make it legal and wont protect you from discipline against your license or criminal charges.
and yes, i worked ltc/snf/sub-acute for years. i never borrowed a drug. never.
i won't borrow narcotics, but no this isn't diversion. everyone got what was prescribed to them.
no they didn't. the parient got a medication prescribed and labeled for another person. it doesn't matter if it was the same drug, it was prescribed and dispensed to another person.
Specializes in Oncology; medical specialty website.
You really do have a very, very thorough and detailed understanding of what happened to your friend. I think that even if something like that had happened specifically to me, I wouldn't be able to remember all the details with such precision, detail, and accuracy.
Is this really about a friend? Or is it a hypothetical presentaton of a situation for some other reason? For example, homework?
Specializes in Gerontology, Med surg, Home Health.
wow that is ridiculous, the DON must not no how to get things done as an RN
I am the DON and I can assure you I know how to get things done. I get them done the RIGHT way that not only protects the residents, but YOUR license as well. We don't make the laws but we need to make sure they are followed.
IMO, if the resident had his/her own card of meds in the building, borrowing was not OK. If a new admit is there, and med-delivery time is another several hours away, I did borrow; I didn't like doing it, but I wasn't going to make someone wait if the med wasn't in the e-box.
"and yes, i worked ltc/snf/sub-acute for years. i never borrowed a drug. never."
when was the last time you worked ltc? what year? never borrowed even colace, vitamin c, and mvi? i commend you then!
did you also finish your med pass within the 1 hour before and after window all the time? if you go over 1 minute the allowed window, did you write medication error report? i hope so!
i would like to know where you worked and how many patients you had on a shift? maybe i can apply there. i work 3-11 shift and have 25 patients with 5 gtubes, 6 fsbs, 1 trach, 6 wound dressings, and very heavy med pass (average meds 10-15 per patient). i am always out of compliance with the 1 hour window and yes management knows about it and they never make me write a medication error report for lateness because i would be writing like 10 every day.
in our facility we can only borrow a narcotic if the supervisor does not have any in the back up and the supervisor has to approve. meaning i sign out the narcotic from patient A to give to patient B and the supervisor signs with me. it's our policy though. other facilities i have worked at frown upon borrowing no matter how badly the patient needs it. it just depends on where you work and what the in house rules are.
Specializes in Leadership, Psych, HomeCare, Amb. Care.
Diverting medications is indeed illegal, but in practice borrowing is often ignored. While corrective discipline does appear to be indicated, the fact that the nurse was terminated makes me wonder if there is more to this than we know.
Not that I want to know someones personal details...
"and yes, i worked ltc/snf/sub-acute for years. i never borrowed a drug. never."
when was the last time you worked ltc? what year? never borrowed even colace, vitamin c, and mvi? i commend you then!
did you also finish your med pass within the 1 hour before and after window all the time? if you go over 1 minute the allowed window, did you write medication error report? i hope so!
i would like to know where you worked and how many patients you had on a shift? maybe i can apply there. i work 3-11 shift and have 25 patients with 5 gtubes, 6 fsbs, 1 trach, 6 wound dressings, and very heavy med pass (average meds 10-15 per patient). i am always out of compliance with the 1 hour window and yes management knows about it and they never make me write a medication error report for lateness because i would be writing like 10 every day.
not that it's relevant to diversion but i'll bite.
total of 10 years between 1989-2009
otc colace and vitamins are non-prescription, otc meds that are house stock for medicaid/medicare patients and are not labeled as belonging to a specific patient. i've never stolen/diverted ("borrowed") a medication labeled and dispensed by a pharmacy for one patient on a different patient.
yes, i gave all my meds in compliance. i wont work in a crap facility that wont adjust med times so they can be given in compliance.
multiple facilities in swwa and nw oregon.
anywhere between 10 sub-acute/vent dependent patients the majority with central lines, tube feedings, wound care and complex weaning schedules, rt handled the trach cares, suctioning, nebs. to upwards of 35 ltc patients that were a mix of healthy little old people who take na asprin and a mvi to bedfast tube feeders on 10-15 meds (i also give those the way you're supposed unless i have an order to mix them).
search withing 25 miles of 98660. sort by rating, pick any of the 6 with 5 stars, they are all excellent facilities where i wouldn't balk at being a patient.
now i have a question...when you "borrow" a medication from patient a to use on patient b do you ask patient a's permission? borrowing anything without permission is theft. those meds don't belong to you or the facility, they aren't yours to borrow or lend.
nightengalegoddess
292 Posts
Don't get too involved with "friend's" business. This may not have been her "first" time with questionable narcotic borrowing. OR, the DON just doesn't like her. Another yucky fact of nursing. Just know, this is a cut throat business no matter how altruistic some of us may be. RNs and LPNs are moving targets. Yuck.