narcotic use by staff

TheCommuter, BSN, RN · Sep 9, 2006

I work in Texas, a state that has a program called TPAPN (Texas Peer Assistance Program for Nurses). Nurses who have tested positive for illicit drugs need to go through TPAPN in order to keep their license from being permanently revoked. A TPAPN order remains on a nurse's license permanently, even though she may have completed the program years ago.

Anyhow, my facility hired an RN with a very recent TPAPN order on her license (May 2006) and, soon after she joined our team, patients began complaining that her pain medicines didn't work. She is not permitted to have the narcotic key in her possession due to this licensure restriction, but occasionally she has the key anyway. Liquid narcotics began to disappear and become 'thinner'. Cards of Tramadol turned up missing when they were supposed to be placed in the D/C med drawer. Benzodiazepines turned up missing. Go figure.

clee1 · Sep 9, 2006

I just don't understand how this can happen, on a systemic or wholesale basis, at least.

At my facility, ONE missing narc will result in the whole staff searching charts, examining the narc locker, etc. until the missing med is found. If it can't be found, the police are called and the whole shift takes a whiz quiz.

I just don't see how any properly run unit can have repeated instances of "missing" narcs. Something HAS to be amiss w/ the proceedures if it can continue to happen.

catlady, BSN, RN · Sep 9, 2006

I just don't understand how this can happen, on a systemic or wholesale basis, at least.
At my facility, ONE missing narc will result in the whole staff searching charts, examining the narc locker, etc. until the missing med is found. If it can't be found, the police are called and the whole shift takes a whiz quiz.
I just don't see how any properly run unit can have repeated instances of "missing" narcs. Something HAS to be amiss w/ the proceedures if it can continue to happen.

Unfortunately, medication theft can be more insidious. A smart thief isn't going to throw off the count. They're going to sign out meds to their patients, but not administer them.

TheCommuter, BSN, RN · Sep 9, 2006

I just don't understand how this can happen, on a systemic or wholesale basis, at least.
At my facility, ONE missing narc will result in the whole staff searching charts, examining the narc locker, etc. until the missing med is found. If it can't be found, the police are called and the whole shift takes a whiz quiz.
I just don't see how any properly run unit can have repeated instances of "missing" narcs. Something HAS to be amiss w/ the proceedures if it can continue to happen.

Nurses who steal medications without throwing off the narcotic count will sign out PRN medications and, instead of administering them to the patient, they will pocket the pills. A clever thief can steal narcotics without any medications officially turning up missing.

Noryn · Sep 9, 2006

It does seem to be a lot more common now. Most thieves are really smart but eventually they do something stupid and get caught. My last job was horrible with the narcotic count. If there was narcotics missing nurses were allowed to write "corrected" on the sheet then sign the book the count was correct. The sheets went in a drawer never to be seen or used again. Kinda scary but that was the way they had done it for 20 years. I would never do this, and it irritated a few nurses but there were other nurses there that felt the way I did. We were labeled "spazzes" but as I have told so many people, I have worked in the ER, there is nothing you can call me that I havent been called.

I always write up an incident report when there are narcotics missing and encourage everyone else to as well. There does need to be an investigation even if it is a pain in the butt. I think perhaps calling the police each time is a bit drastic but trends should be observed. At my former job, there was a new nurse who was talked into correcting the count and she had wanted me to sign off. I took her to the side and explained to her how much jeopardy she was putting herself in. I think there was an Ambien missing, well she and I wrote up an incident report and the next day the pharmacist came in saying, "I forgot to sign out for an Ambien I had to borrow for another patient." I think it would have raised flags if we had accounted for a drug that wasnt there but to be honest at that job it probably wouldnt have.

I think there has been a much increased demand for prescription pain medication now. Used to be it was the illegal street drugs but now the new synthetic opiates and amphetamines are really popular to abuse.

weetziebat · Sep 9, 2006

Does it seem too far-fetched to wonder if perhaps some people become nurses because they know they will have access to narcotics? To me it seems like far too much trouble, but maybe some don't look at it that way?

puggymae · Sep 9, 2006

No it doesn't seem far fetched to me at all that someone would become a nurse in order to have access to narcotics. A person I went to high school with showed up 10 years after graduation as an RN at the facility I worked at. I expressed astonishment because he had went to school to be a librarian. When I questioned him he point blank said: "I went to nursing school so that I could have the narcotic keys." I told the DON about that statement and she told me that he was just kidding me. He wasn't kidding. He exibited every sign of an addict nurse that you can think of. Of course it caught up to him, and he was fired. Several years later he died of an overdose. Sad.

jncRN · Sep 9, 2006

I am in my final year of nursing school, and I have seen situations during my clinical rotations that I think would make it way too easy for someone to steal narcotics.

The policy at the hospital where I worked during my last rotation is that narcotics have to be signed out by two RNs...the one who will be administering the med, and another RN to witness. I was shocked to see that there were people who would just sign it out, and then leave the sign-out sheet on the med room counter, with the unspoken understanding that the next RN to come into the med room would sign as their "witness".

When I brought this practice up with my clinical instructor, I was again floored when she said that this was common practice, as the nurses were "covering each other" because it was too time-consuming to find another RN to come into the med room for a second to sign off with you. Whaaaaaat?

As a new grad in 2007, I don't care if other nurses label me as "difficult" or whatever, I am NOT going to be doing this for anyone, and I will be dragging the nearest RN into the med room with me whenever I need to sign out narcotics...with a bright smile and the promise that they can drag me in to sign for them whenever they need to do so. What the heck is the policy for if no one follows it? :nono:

madwife2002, BSN, RN · Sep 9, 2006

I have seen the practice where you need another RN's to sign on the computer that you are removing the narcotic and if the drug is too much sign to say you wasted 1 or 2 mgs but never ever seen if you give it or waste said amount. NO checking was done ever. One day I found a whole vial of morphine in the middle of a doorway to a pts room, I picked it up and took it to the nurse in charge-No further investigation was done apart from the check which showed nothing missing. Oh thats all right then-nobody seemed concerned that somebody had drawn morphine for a pt and that pt hadnt had the drug? Oh yeah and there wasnt a pt on the floor that night shouting in pain and saying he hadnt recieved his morphine.

paigeRN1962 · Sep 17, 2006

I've just started working in an office-based plastic surgery center which is certified by the AAAHC. Before I started working there, all the narcotic records were co-signed by the physician in time for the inspectors however none of the discrepanies were noticed or reconciled. I'm not talking about a small amount either. Conscious sedation is used here and multidose vials are used, leading to hundreds of cc's unaccounted for and unreconciled. As another vial is opened, the RN just added it to a running total which of course is totally bogus.....no way does any of it add up. No daily counts are done and it took me about 30 seconds to see the mess and made me wonder how the glaring lack of narcotic accountability could be going on without anyone figuring it out during the certification process.

Obviously the physician either doesn't want to know or doesn't care that he co-signed counts that don't reconcile and have huge discrepancies. I have refused to administer narcs or sign my name to anything having to do with these drug. I suspect that there is drug diversion going on but have not witnessed anything out-right. The nurse who hired me and one other nurse is unwilling to let either of us carry the keys, is the only one giving conscious sedation and is unwilling to allow any patients I've recovered have any pain medicine. The other day,the CRNA drew up a very small dose of Demerol for the patient we were recovering and I documented that she gave the first half and I the second half to this patient. The RN I suspect of diverting acted like we were ridiculous and I got a big eye-roll for giving 12.5 mg of Demerol. I have very uneasy feelings about this place and am looking for another position.

rach_nc_03 · Sep 18, 2006

when I worked in a PICU, the common practice was to leave drawn-up syringes of narcs and sedatives in the bedside cart drawer during your shift, since they were pushed so frequently. The carts were unlocked. The 'official' policy was to waste them at the end of your shift, but I never witnessed anyone actually do that. Almost every shift, I'd open the drawer and find a fistful of syringes of morphine, ketamine, fentanyl...you name it- some with dates from 2 or 3 days prior. I always wasted them with another nurse present, which irritated some- but I just *knew* that the issue would come up one day, and I didn't want to give anyone reason to suspect I was diverting.

I also suspect there were parents who took these 'freebies'.