i've heard this happened before to somebody else but i never thought this is going to happen to me and bang i t happened to me today. just for a info this is a ltc setting and we get our narcotics in a blaster packs and keep it in a double locked door. during my shift a staff from pharmacy called and asked me that they received a reorder form for ms contin and said they sent this medicine few days ago and we still should have this medicine. so i checked the double locked narcotic box but couldnt find the whole blister pack of this medicine. since this med was given for few days, i looked in the narcotic sign out book to see who was the last person who gave this medicine and there was no narcotic sign out sheet of this medicine also. since a doctor increased the dosage of this medicine i thought a nurse returned this medicine to don to be wasted so i called supervisor and notified of this and asked her if somebody returned this medicine to the unit manager to be wasted by her and don. supervisor went to a room where they keep all the narcotics that needs to be wasted and didnt find this medicine and the sign out sheet. since this is the first time that i've experienced this i panicked. i told my supervisor that i wanted to call the police, because immediately i felt my job and license was on the line. i mean think about it. if you are the one who find out the whole blister pack of narcotic is missing, what would other people think? they are going to think that since i have the key to narcotic box, i took the narcotic and the paper or i took those pills while i was working there during my shift. if narcotic is missing isnt police suppose to be called to investigate?
so the supervisor called don and adon and they told her that they are going to do a full investigation on monday. i asked supervisor if i should fill out an incident report and she told me no i dont have to. and she told me to call the doctor and change to the previous dosage. i asked her if i should call the pharmacy and ask them if somebody accidently returned it to pharmacy and she also said no. with that i became suspicious. i felt like they are trying to cover up their ass. but why? and who are they going to blame if they cant find the medicine? one option would be me. they are going to say i who woked the shift when the narcotic became missing or found out narcotic is missing took the blister pack and the paper. and with that theres possiblity i will lose my license. what would you have done in this situation? i am so so so streseed out right now and i'm so scared. :sstrs::yldhdbng::yldhdbng::hdvwl:
You have gotten some very good advice from the other posters. I will add however, that I wouldn't ask about filling anything out, I would just do it. This is an incident and needs to be documented as such. Fill out the report and keep a copy for yourself just in case. the reason they told you not to fill anything out is so there isn't a record of this and they can cover it up.
I agree, file an incident report, fully document everything reported from the pharmacy and your actions, including reporting the missing drug to the supervisor. No one is above a closer look in this situation, but I do not feel you have to worry. You did not accept the drug, did not divert the drug, nor did you ignore the pharmacy notification the drug was sent. In the end, it will be found out, and the proper person will be found. I know how "freaked" you feel though. I hate it when pill/card count if off, even if it is just a minor error, in LTC there is too much rumor about drugs being diverted to take any incident less than serious.
Not only should you make an incident report but you should also get the name of the pharmacist you spoke with and the date and time you did so. Remember, though, that incident reports go to the one who told you not to make one - the Nursing Sup/DON. Therefore, you should also "let it slip" to the Administrator that this is happening. The DON might be trying to keep it from the Administrator and here you are, sort of in the middle, although the fact that Pharmacy is aware makes it harder for the culprit to keep it quiet.
wow, notifying the DEA makes it sound really serious. Is that the procedure facilities are required to follow in cases like this?
Sorry you're having problems! I feel for you. I know how worked up I get over things like that. Even if you can't, because of your boss, file an official incident report write everything down in a journal including who you talked to, what was said, etc, times dates etc. I've always been a CYA girl. I've been accused of overdocumenting when I worked as a CMA, but it's never come back to bite me in the long run.
Not to hijack the thread....but, I'm a new nurse in LTC and I'm clueless to what the "tell-tale signs" are. Can someone give examples, please? TIA
The person who stole the whole card in the case I had, also used to give a large amount of PRN pain meds to people that usually did not complain of pain. The other nurses on the floor wouldn't be giving as many PRNs as her. Also some very forgetful patients used to complain of pain after she worked. For example, someone who really wouldn't remember what sort of pills they took but was taking narcotics for pain routinely most likely didn't get their pain pills on her shift, though that was never proven.
It definitely sounds like someone has diverted it. Narcotics are to be signed in two places, and they covered their tracks. However, they may or may not get found out on this incident. However, they will evevtually screw up.
I know we had an incident one time. Actually, it wasn't even narcotics. It was antidepressant pulled from stock meds. They were blister packs. I felt a little nervous about it because it was the exact antidepressant that I was on. But, I told the DON, if they were going to take a an antidepressant pill from the stock, why wouldn't they have just taken the whole card? It would appear a lot less obvious. It was just weird. An odd situation, to pull an antidepresasant med!
Specializes in Gerontology, Med surg, Home Health.
Not only should you make an incident report but you should also get the name of the pharmacist you spoke with and the date and time you did so. Remember, though, that incident reports go to the one who told you not to make one - the Nursing Sup/DON. Therefore, you should also "let it slip" to the Administrator that this is happening. The DON might be trying to keep it from the Administrator and here you are, sort of in the middle, although the fact that Pharmacy is aware makes it harder for the culprit to keep it quiet.
wow, notifying the DEA makes it sound really serious. Is that the procedure facilities are required to follow in cases like this?
Yes...you must report this or any other serious infraction to the DEA. I had an agency nurse fall asleep at the med cart. I got a call from the floor...had her sent home and then was told she made 'hundreds of errors'. It wasn't hundreds but her behavior was such that I investigated and reported her to the BON. The Board reported it to the DPH AND the DEA. I was surprised because there were no narcotics involved, but the woman from the DEA said they deal with ANY kind of medication issues. Always better to over report. Luckily I had reported to the BON and had had the DEA out to my facility previously. That surveyor told her boss that 'this DNS investigates and reports everything" so I didn't get cited for not notifying EVERYONE that one time.
This happened at my last facility. I (the DNS) was immediately notified and I immediately started an investigation. I didn't call the police, but I did notify the DEA. In your situation, if I were the DNS, I would start by looking through every blister pack in the med cart, narcotic and non narcotics to see if the card wasn't misplaced honestly. Then I would call the pharmacy and get a copy of the invoice so I could tell who signed for the narc. IF the nurse who signed the narc in didn't make a page for it in the narc book, .....well you get my point. These things have to be thoroughly investigated. I reviewed narcotic documentation with my nurses almost once a month and had them sign inservice sheets. That way when the DEA came in, the surveyor knew that the nurses had been told the right way to do things so she couldn't blame the facility or me for their stupidity or sloppy practice.
cape....i work in ct and mass....in ct their narc book is completely different....the sign out "sheet" comes from the pharm, ncf,the receiving nurse signs for the med and fills out the top with their sig, # of doses, date and time, some places have lines for two sig, some only one...and then the front copy goes in the "narc" book. loose leaf note book style....and the back copy goes to the dns.....i think this is the sort of system the op is referring to.......
if an individual is found to be diverting controlled substances, reports have to be filed with the appropriate state board (i.e., pharmacy, nursing, medical).
requirements for reporting to state authorities vary. check with your state board of pharmacy and nursing for reporting requirements. ...
federal regulations
federal regulations require that all thefts and any significant losses must be reported to the dea immediately upon discovery of the theft or loss. notification must be accomplished by completing and filing a dea form 106, report of loss or theft. the form my be found on the internet at www.deadiversion.usdoj.gov or may be obtained from your local dea office. if the circumstances regarding the theft or loss need clarification before the form can be completed, the registrant can make an initial report via telephone or some other means and file the completed form as soon as the circumstances are known.
Yes...you must report this or any other serious infraction to the DEA. I had an agency nurse fall asleep at the med cart. I got a call from the floor...had her sent home and then was told she made 'hundreds of errors'. It wasn't hundreds but her behavior was such that I investigated and reported her to the BON. The Board reported it to the DPH AND the DEA. I was surprised because there were no narcotics involved, but the woman from the DEA said they deal with ANY kind of medication issues. Always better to over report. Luckily I had reported to the BON and had had the DEA out to my facility previously. That surveyor told her boss that 'this DNS investigates and reports everything" so I didn't get cited for not notifying EVERYONE that one time.
Do I remember correctly- she didn't lose her license?
tvccrn, ASN, RN
762 Posts
You have gotten some very good advice from the other posters. I will add however, that I wouldn't ask about filling anything out, I would just do it. This is an incident and needs to be documented as such. Fill out the report and keep a copy for yourself just in case. the reason they told you not to fill anything out is so there isn't a record of this and they can cover it up.