Narcotic Irregularities

[AlexCCRN]

How do you report a pattern of narcotic medication record irregularities without making it personal. A few specific nurses consistently remove narcotics NOT ordered, presumably administered under the pretense it would be what the MD would order but never secure an order. Or, have vague explainations for meds removed - found in the PYXIS report but no administration record entry for that med. Or, removed meds but apparently - appears as if - given much later - 6 hours later? Or, record/sign that 80 mg IV morphine given at 10mg intervals over 10 hrs but elderly narcotic naive DNR patient's clinical signs don't add up. Or, meds removed under my patient but not administered? Just a few examples of my observations. I have a record of many more. Recently faced with a narcotic "discrepency" created from a previous shift but I'm left holding the bag because my count generated the difference. I'm concerened about how the patients are being treated but also worried that I'm somehow part of the "action" - unvoluntarily :)

[leslie :-D]

what about writing an incident report and hand delivering to the nm?

i would share your findings with the charge nurse then write in the incident report, that charge nurse is aware. you don't want to handle this alone. much luck to you.

leslie

[canoehead, BSN, RN]

I would write an incident report on every one of them. Make a point of not delegating narcotic administration to your patients, and let your NM know you will be doing that. I might even go so far as to say to your coworkers that you've noticed some unusual patterns, and you want to make sure you don't get involved if there is a problem.

It's a very serious problem, and you want to get as far away as you can from the suspect, and from his/her methods of diversion. So give single doses, even if you have to waste more often, insist that your witness watch the waste, do whatever you can to separate yourself from the problem.

[meownsmile, BSN, RN]

I agree, single dose sign out only and waste what you dont use. This is one situation where covering your behind is critical. Im not sure what type of facility you work in but that many discrepancies out of a pyxsis is a major problem. And i agree, write up every incident of discrepancy, or late given dose. If you sign it out at 8 and dont give it till 12 its a problem. Write it up if it involves you or your watch on the patient.

[laurakoko]

Cya.............cover your....

[DutchgirlRN, ASN, RN]

I have a record of many more. Recently faced with a narcotic "discrepency" created from a previous shift but I'm left holding the bag because my count generated the difference. I'm concerened about how the patients are being treated but also worried that I'm somehow part of the "action" - unvoluntarily :)

I've never personally noticed any nurse taking out narcotics that were not ordered for the patient. With our system they would have to pull it from the pyxis as an override which would undoubtedly raise a red flag in the pharmacy if it was pulled and never scanned when given. Additionally with our pysis, once the nurse signs in, she could take out narcotics for any patient on the floor but it would be on record who pulled the narcotics. If a nurse was pulling narcotics for a patient that wasn't hers that also raising a red flag. I don't know if all pysis' systems work the same but I feel very comfortable with the safeguards that ours have in place.

I do know that several nurses have been approached because their percentage of narcotics pulled were far higher than other nurses.

I've been asked to watch nurses, I refuse, however I do offer to check up with their patients, as a charge nurse, to see if their patients have asked for pain meds, how many pills they got and whether or not they got relief after their dose was given whether it was PO, IM or IV.

[nuresnia]

I've never personally noticed any nurse taking out narcotics that were not ordered for the patient. With our system they would have to pull it from the pyxis as an override which would undoubtedly raise a red flag in the pharmacy if it was pulled and never scanned when given. Additionally with our pysis, once the nurse signs in, she could take out narcotics for any patient on the floor but it would be on record who pulled the narcotics. If a nurse was pulling narcotics for a patient that wasn't hers that also raising a red flag. I don't know if all pysis' systems work the same but I feel very comfortable with the safeguards that ours have in place.

I do know that several nurses have been approached because their percentage of narcotics pulled were far higher than other nurses.

I've been asked to watch nurses, I refuse, however I do offer to check up with their patients, as a charge nurse, to see if their patients have asked for pain meds, how many pills they got and whether or not they got relief after their dose was given whether it was PO, IM or IV.

Some pixis systems are not connected to pharmacy and have to be counted every shift. This happened to me on the 11-7 shift the chg nurse was only removing meds for post op pt of the LVN's to give IVP pain meds and only the confused pt's . I was double checking all the pain meds given from the pixis on my pt's and the times that the meds was taken out was when I was at the bedside and the chg nurse was not in the room I had a witness another LVN we were both turning the paticular pt. and we both double checked the medication was charted at that time, this also happened to her pt this was reported and the charge nurse confessed she was taking the medication . the nurse went throu tpapn and now she is a NP

[DutchgirlRN, ASN, RN]

Some pixis systems are not connected to pharmacy and have to be counted every shift. This happened to me on the 11-7 shift the chg nurse was only removing meds for post op pt of the LVN's to give IVP pain meds and only the confused pt's . I was double checking all the pain meds given from the pixis on my pt's and the times that the meds was taken out was when I was at the bedside and the chg nurse was not in the room I had a witness another LVN we were both turning the paticular pt. and we both double checked the medication was charted at that time, this also happened to her pt this was reported and the charge nurse confessed she was taking the medication . the nurse went throu tpapn and now she is a NP

Gee I wonder why they are not connected to the pharmacy? Seems as though they would want them to be. Thanks for explaining that there are differences, I honestly didn't know. Thanks!

[nuresnia]

Gee I wonder why they are not connected to the pharmacy? Seems as though they would want them to be. Thanks for explaining that there are differences, I honestly didn't know. Thanks!

Since that incident the whole system was changed and now use a sure med for all patients medications