Nurse giving discontinue medications to other patients

[Nurse Amy Jolie]

Hello all,

I work as Director (RN) in a small unit ( assisted Living)of about 21 residents. A female patient was admitted yesterday to my unit. I made sure that all her meds were coming as the patient has some psych issues, confusion... However, one of my nurses got there this morning, got a report that patient only slept 2 hours all night. Patient has order for Haldol and ativan prn. Nurse said that she could not find patient haldol, so she went to med room were we keep overflows and d/c meds and she found d/c haldol of a former resident and gave it to the new patient!!(scary). I know this is unacceptable, however what is the policy of the nurse practice act for such issue? There was no harm cause. Can the nurse be fired for this? please help

[BuckyBadgerRN, ASN, RN]

If the resident has an Rx for the medication, I don't see the problem. Now if there WAS no Rx, now you've got a serious issue....

[Nurse Amy Jolie]

Thank you for replying!

[Nurse Amy Jolie]

Thank you for replying. Yes the pharmacy delivered the medication the night before. The nurse could not find it as previous nurse left it on top drawer in med cart (per nurse in question)

[Nurse Amy Jolie]

Klone,

I am not asking you how the nurse should be disciplined, I am asking if the nurse can be fired for this action. First of all let me tell you that she is one of my favorite nurses and I am trying to understand how to deal with this.

For you asking how much training I had and How long I have been a Nurse makes me think that as a Nurse I am supposed to know all the answers. You can be a nurse for 30 years, you can be a nurse with a DNP But still you will Never know all the answers, sometimes even the simplest one. It does not matter how long you been a nurse, What counts for me is asking and getting answers on things that I don't know instead of jumping to conclusion. I don't judge anybody's intelligence or skills based on questions that they ask. No one is perfect and no one knows it all

[Nurse Amy Jolie]

Thank you for replying. No we don't keep an e-kit. Yes the pharmacy delivered the medication in a timely manner. Previous nurse left it in the first drawer of med cart, which made it hard for Nurse B to find it as it was in the wrong location. I am not looking for reasons to fire the nurse at all. Like I said in my post, there no harm caused and company does not allow that.

[ClearBlueOctoberSky]

Thank you for replying. No we don't keep an e-kit. Yes the pharmacy delivered the medication in a timely manner. Previous nurse left it in the first drawer of med cart which made it hard for Nurse B to find it as it was in the wrong location. I am not looking for reasons to fire the nurse at all. Like I said in my post, there no harm caused and company does not allow that.[/quote']

Then for this, I would do educational moments and Inservice all of your nurses on the importance of placing meds in the proper location. Inservice them on the possible consequences of borrowing discarded meds, and I might talk to the pharmacy about stocking E-Kits of not only your most commons meds, but of narcotics as well.

Create and educate on the policies for not finding medications, including contacting pharmacy to make sure that they have been delivered and then pulling the needed med out of the E-Kit.

I'm not a DNS, but I am on the Nurse Leadership Team. I wouldn't think that this is a fireable offense. It is an Operational error. Look at the policies and see what can be improved on.

[Nurse Amy Jolie]

Ok, thank you for your suggestions

[MunoRN, RN]

What any BON expects, and what I hope you would expect as well, is that Nurses do what is necessary to provide patients with safe and effective care. If anything, a Nurse would have more to worry about in terms of issues with the BON if they assessed a need for haldol/ativan, had it available and the ability to give it safely, and yet didn't give it, regardless of poorly thought out company policies.

As a DON, good patient care should be your goal as well, rather than being yet another barrier in between your nurses and good patient care.

[Nurse Amy Jolie]

MunoRN,

Yes Good patient care is my primary focus, that why someone using an unsealed d/c haldol that is sheduled to be destroyed bothers me and I am searching for ideas. Thank you for replying.

[MunoRN, RN]

I guess I'm not really sure what your rationale is for finding that so concerning. If the patient's intended bottle wasn't misplaced, wouldn't their dose also have come out of an unsealed bottle?

I'd understand your position better if you could explain what you feel should have been done (other than finding the patient's own bottle).

[RNfaster]

What about the person that didn't put the drug in the right place? Honestly, though, I wouldn't fire either of them. I'd talk to them. I'd also review institutional issues.

I have heard of the issue related to insurance fraud (in SNFs) as a reason to only give properly labeled meds to the right person. I don't know much about it. If I was in charge, I'd review institutional policy, rationales, and other requirements. I'd then look at drug intake issues and also staff education. I'd make sure folks knew how to properly receive medications, destroy medications, etc. I'd also look into recycling of meds, provided it was permissible. I wouldn't fire anyone for this stuff. I'd just educate them in what to do and the related rationales...and make sure they had the medications they needed to do their jobs.

It sounds to me like the nurse you're considering negative action on took creative action and met the needs of her resident. It sounds like the system and its leadership failed her and the resident. Get an E-kit for your facility so this doesn't have to happen in future should another med be missing. As mentioned, devise a med intake system and teach folks to use it.

[kungpoopanda]

Of course, she could have left a vulnerable patient become stressed and agitated through sleeplessness. Would this have been the correct course of action?

To be quite honest, you sound clueless and are trying to throw your weight around in compensation.