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:
I thought narcotics, the storage and documentation were federally regulated. Learn something every day.
the first time i worked in Ct, i nearly had heart failure....thought for sure this exact prob would happen. i think it is much harder to pull off when you have consistent staff.....that is how we caught it when it happened on my "watch"..
Happened to us too. Whole cards of the drug would be missing. Well, not the whole full card, but the entire card would be missing. The med would be signed in. Pharm sheet at delivery and in the narc book. This nurse would take the card and drug sign out sheet then the med would be re ordered by the next nurse or even that nurse. Sometimes it would be 2 or more cards at a time. Most of the missing cards would be on residents that didn't use the prns every day or then again..it was on anyone.
This didn't happen on an 11-7 shift and could happen on any shift.
I noted it when I would work the weekends, reorder a drug or two and if I would pick up extra hrs during the week...the drug was missing and I knew that I just reordered it and the resident shouldn't have finished it.
Was very hard to prove this case and took a while for adm to get her and I'm not even sure if this person was fired or quit.
This suspected nurse was a very good nurse and didn't have all the signs of a diverter. We think she was stealing them to sell. She even offered to drug test when someone thought it could be her.
soooo...sit back, if it is not a harmless mistake...it will probably happen again. Make those notes that you did. Like when you found out, that you notified the DON, who you spoke with at pharmacy etc.
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
Gives PRN narcotics to residents who rarely/never c/o pain when other nurses are assigned to them
Gives PRN's at every opportunity....say q4hr to residents that NEVER have to have them that often when others are caring for them
Let's it be known to other staff that she has a "script" for Lortab, Ativan, Xanax, etc...... and that she "had to take some" before coming to work.
Has residents c/o that they didn't get their scheduled dose of pain med at xx time, however, diverting nurse will say "they are just confused" and her documentation will back up their c/o pain, her administration of pain meds, and of course, some form of confusion on the residents part.
Comes to work wide awake, but as the shift progresses, becomes more and more somber.
Signs her narcotics out at one time, instead of the correct way....when she gives them.
Leaves the facility for a "break" immediately after her med passes
Goes to her car for mini breaks throughout the shift.
Fentanyl patches on her residents are frequently found to be missing after her shift, however most often she is clever and will document that it was not found during her assessment on her previous shift.
There is no rhyme or reason to the way she works, in other words, she doesn't have a system. She is all over the place, in and out of the med carts, backtracking to "skipped" rooms.
She offers to "check in" pharmacy deliveries for other nurses.
She has to "refer" to her narcotic book during charting. ***? You are giving so many narcs that you can't remember who you gave them to? PU-LEEEZE
I have been worried recently about not one but two nurses I work with. One is on Ativan, she tells everyone she takes it daily, and the other just acts strange and seems to "space" a lot. With everything else going on, I do not need to worry about drug diversion on a regular basis. Prayer accepted.
thank you everyone for your help. i forgot to mention that i rememered reading a thread from this website that as long as we are following the policy and procedure, we are less likely to get into trouble. so i filled out a medication related incident report form. the next day, my supervisor found a pack of missing medicine and also the sign out sheet. it was in the unit manager's office. has this unit manager followed the policy and placed the narctic in the right room this kind of thing could never have happened. i'm relieved that everything is back to normal. i want to thank allnurses for all the help and i have to say...
I have gone thru similar situation x2 at same facility. I felt I was set up but they could not prove where the meds were taken. The RN who counted with me took home a 1/2 full bottle of Roxanol and went on a week vacation. I never saw or heard what happened to the missing bottle or narc sheet and she still works there. I documented every word, dates, & times everything happened. I later heard after I left there, another LPN was taking oxycontin that she was getting from the facility. I even told the DON I felt I was being set up and she could not look me in the eye or say anything. I would be calling the pharmacy myself to have them fax you a copy of the delivery sheet that was signed by receiving nurse. Protect yourself at all costs. Document, document, document.
Hope your situation is resolved soon, so your worries can be dismissed.
If the pharmacy delivered these narcs to your facility then they should have signature from the person that they delivered them to. If they have that information then, there must be a problem somewhere in the facility. The fact that the pharmacy contacted you makes me think that the meds never made it to the facility. If they sent them and have no record of them being recieved, then the pharmacy better start wondering about the people who deliver meds.
Ms RN- Everyone gets nervouse in these situations. First of all all narcotics have counter sheets. Even if they are discontinued a counter sheet stays with them. I can see where someone can take an entire blister pack and counter sheet and no one would notice during count. I mean how would someone know if there was a narcotic and counter sheet in a narc drawer then removed before they signed onto the shift?
I assumed you counted with another nurse at the beginning of the shift. Unless they were to swear that they saw the narcotic and the counter sheet get endorsed to you then there is no proof that you had anything to do with the disappearance of this narcotic.
Someone can look at the Residents MAR and find out the last time this narcotic was given. That might be a clue as to how long this med could have been missing for.
Because it is a narcotic they do have to investigate the situation. They will try to figure out what happened to the narcotic. Someone had to of signed it in when the pharmacy delivered it. So they will know for sure someone was responsible for it. Then they will look at the dates and times somone signed it out on the MAR.
I have always hated the way Discontinued Narcotics have been handled. I remember having to count for narcotics that were locked in the fridge and someone getting upset cause I would go to the fridge and check that the meds were there before signing the narcotic counter sheet.
Dont worry they will have to talk to all nurses involved not just you. They cant accuse you of taking the medication without proof.
I agree with all the previous posts esp. the signing the receipt from the pharmacy. Also keep in mind that even though this is the first time you've been through this, the administration has been through this sort of thing many times. Just be sure you've documented every thing carefully and continue on with your work. I hope you find out what happened soon.
morte, LPN, LVN
7,015 Posts
the first time i worked in Ct, i nearly had heart failure....thought for sure this exact prob would happen. i think it is much harder to pull off when you have consistent staff.....that is how we caught it when it happened on my "watch"..