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.
First question I'd ask is "What was the Supervisor busy with at the time?" If this really is a true scenario, and not a homework question, why did she leave the nurse to struggle with an overwhelming work load, then add to it? If she saw the nurse was busy to the extent described, what prevented her from answering the call bell?
The nurse made a judgement call and chose the wrong way; at the time it seemed like the only logical solution to her. This is not reason for termination, but counseling and re-education. Sounds like she was set up; in her shoes, and assuming we've heard the whole story, I'd seek legal advice.
Ok here's my chance to learn something new. Why is borrowing a bad thing? Does it make it harder to catch a true diversion of meds? Does it wrongfully charge another pt for the med? I can see it could cause an inadvertant dosage error, but otherwise, why not take the easiest path?
Aside from all the potential med error issues, the patients are paying for those meds. So a card full of pills for Mr. Smith costs x dollars a pill; you take one of those pills for Mr. Jones well, he just got a free pill that Mr. Smith paid for. Every now and again is one thing, but if it's being done on a regular basis -- and some facilities are so disorganized that it's a total free-for-all -- well Mr. Smith, or his insurance, is paying a whole lot of money for medications that are going to other patients. Some of those meds are expensive! We're talking $8, $9, $10 dollars a pill, so it can really add up.
In addition to which, it's insurance/Medicare fraud, and theft, to charge Mr. Smith for 30 pills that are going to other patients.
As far as the narc, again it's a payment issue, but it's also a potential diversion issue in that it's difficult to reconcile why one patient doesn't have his own meds, why another has extra, and where did all those extra meds actually go? Usually, if everyone is playing by the rules, you can just do an investigation and cover all possibilities and account for the med; but it does warrant a full-on investigation, and now the facility has to account for why the system failed on their end, and hat nurse is going to be in the hot seat until it gets sorted out.
Specializes in Gerontology, Med surg, Home Health.
A nurse in Massachusetts lost her license for giving a coworker two tylenol from the med cart. The DPH happened to be in the building at the time and said it was dispensing without a license. So you can imagine how they would feel about using narcotics thatbhad been prescribed for one person to a different person. If we don't have a particular pain med in the ekit, we call the doc and ask for an order for something we do have.
Ok here's my chance to learn something new. Why is borrowing a bad thing? Does it make it harder to catch a true diversion of meds? Does it wrongfully charge another pt for the med? I can see it could cause an inadvertant dosage error, but otherwise, why not take the easiest path?
Because it's against the law to give a prescription drug to anyone other than the person whose name is on the label.
Unfortunately, it is against the law. Now do most staff that pass meds in ltc end up doing that? Yes, I know I did. You get stuck between a rock and a hard place. When the carts change over, meds get screwed up, some are there, others aren't, or you don't work that floor often and find someone forgot to reorder meds or pharmacy is turtle slow and hasn't gotten there with them yet. So you borrow and hope you don't get nailed for it.
Where I work, it's overlooked unless someone brings it to someones attention. Pharmacy delivers 1x day on the noc shift and rarely on the weekend. It's not okay to not give the med that has been ongoing with the phycisians order, but it's also not okay to not give it. Not everything you need is in contingency. What do yo do? We borrow. I do have to say that I will not borrow narcs. Way to slippery for me. I'm not sure it doesn't happen, but it's not my practice to do so.
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nightengalegoddess
292 Posts
PS Only probably 10% of nurses are lousy. Just want to make that clear. Not slashing my own.