Narcotic Question

marienm, RN, CCRN · Sep 8, 2020

Where does the narcotic card come from and what is its purpose? Is it the record of narcotic wastes and removals used by staff? If so, why doesn't it match the orders? I'm not sure it is "fraud" per se but I would be uncomfortable wasting part of a tablet if the sign-out sheet made it look like I had no reason to waste it. But I would get the sheet corrected, not withhold the med.

Purple_Clover · Sep 8, 2020

4 hours ago, marienm, RN, CCRN said:

Where does the narcotic card come from and what is its purpose? Is it the record of narcotic wastes and removals used by staff? If so, why doesn't it match the orders? I'm not sure it is "fraud" per se but I would be uncomfortable wasting part of a tablet if the sign-out sheet made it look like I had no reason to waste it. But I would get the sheet corrected, not withhold the med.

The card contains the physical pills and directions for them. However, sometimes the card is not current with the current orders (on the computer; the orders we go by)

marienm, RN, CCRN · Sep 8, 2020

So this is a card of patient-specific pills that was prepared in advance and then the order changed? Like Mrs. Smith's med drawer has a card of meds including her nightly 0.5mg Ativan tablets stocked on Monday, but then her dose got changed on Tuesday and the next re-stock isn't until Wednesday at which time either 0.25mg tablets will be stocked or the administration instructions will be updated? (Sorry for the questions; I'm hospital-based where every dose is pulled directly from the computerized storage system at the time of administration.) I agree with you that you should be following the current order. And surely this has happened before...does your facility have a procedure for what you're supposed to do if a med dose changes in between re-stocks? Maybe your manager needs to reassure this nurse that she's not violating this policy and also clarify with her that the current order in the computer is the one to use. (Also, how rigorous is your witnessed-waste process? Is she afraid of being accused of not actually wasting the partial tablet?)

TwoLayi, ADN, BSN, RN · Sep 9, 2020

22 hours ago, Purple_Clover said:

Hey everyone!

So, there is this new (to our facility) nurse who is saying that it is fraudulent to give a narcotic (that you have a order for) which doesn't match with the instructions printed on the narcotic card (where the pills are). For example, they are saying that giving 1/2 of a pill (and wasting the other half) is not legal ("fraud" in their words) because the card says to give a whole pill, when the current order says 0.25mg (changed from an initial 0.5mg).

(I'm open to the possibility that I'm wrong) but I don't understand how it can be fraudulent to give the correct dose (1/2 tab) as long as the other half is wasted and you have a valid order.

Thoughts? Any links to any sources?

Thanks in advance!

I believe fraud is documenting and/or billing for services not rendered. When I worked in skilled nursing, what you described would happen all the time and it seemed so wasteful getting rid of whole cards of meds. Also there was always a delay from the pharmacy. The only time it would be an issue is when it was time for the yearly state survey. The state would consider it a med error if the instructions on the card didn't match the order.

Purple_Clover · Sep 12, 2020

On 9/8/2020 at 12:37 PM, marienm, RN, CCRN said:

So this is a card of patient-specific pills that was prepared in advance and then the order changed? Like Mrs. Smith's med drawer has a card of meds including her nightly 0.5mg Ativan tablets stocked on Monday, but then her dose got changed on Tuesday and the next re-stock isn't until Wednesday at which time either 0.25mg tablets will be stocked or the administration instructions will be updated? (Sorry for the questions; I'm hospital-based where every dose is pulled directly from the computerized storage system at the time of administration.) I agree with you that you should be following the current order. And surely this has happened before...does your facility have a procedure for what you're supposed to do if a med dose changes in between re-stocks? Maybe your manager needs to reassure this nurse that she's not violating this policy and also clarify with her that the current order in the computer is the one to use. (Also, how rigorous is your witnessed-waste process? Is she afraid of being accused of not actually wasting the partial tablet?)

Yeah, in most LTC facilities, they get a blister pack of meds. So we had an existing blister pack of 0.5's and the order was changed to 0.25. It usually takes at least a day for us to get the new dose in.

heron, ASN, RN · Sep 12, 2020

In my building, we use pharmacy-supplied stickers for the card that say “directions changed, refer to chart”. Then we give the new dose and waste if necessary - no taping leftover 1/2 tabs back into the card. When the card is empty, then pharmacy sends the new dose and directions.

Dani_Mila, BSN, RN · Nov 28, 2020

On 9/12/2020 at 3:09 PM, heron said:

In my building, we use pharmacy-supplied stickers for the card that say “directions changed, refer to chart”. Then we give the new dose and waste if necessary - no taping leftover 1/2 tabs back into the card. When the card is empty, then pharmacy sends the new dose and directions.

Same method at my job