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

[onyx77]

It's certainly not unheard of for ALFs, ECFs, and hospitals to pre-allocate medications for specific patients (they are bottled, bagged, etc) by pharmacies either in-house or off-site which makes both administration and auditing easier, and are returned to the same pharmacies for re-allocation after discharge, but they are still "house stock" medications and are not the property of the patient until administered.

Actually this is incorrect. A resident in an AL (and LTC if not on a med a stay) privately pays for their meds. If staff is administering meds they are more than likely coming bubble packed and labeled for that individual. A pharmacy will not send the med without first billing the resident's insurance. The resident is responsible for any copays or whatever their plan does not cover. They personally receive this bill. Thus, borrowing from another resident is fraud/ stealing.

Another thing to add is that ALFs (not sure if its state specific or not) canNOT have an e-kit or contingency per regulations.

[MunoRN, RN]

Actually this is incorrect. A resident in an AL (and LTC if not on a med a stay) privately pays for their meds. If staff is administering meds they are more than likely coming bubble packed and labeled for that individual. A pharmacy will not send the med without first billing the resident's insurance. The resident is responsible for any copays or whatever their plan does not cover. They personally receive this bill. Thus, borrowing from another resident is fraud/ stealing.

Another thing to add is that ALFs (not sure if its state specific or not) canNOT have an e-kit or contingency per regulations.

That's true when assisting with self-administration, which is different from administering meds. You often can't use an e-kit to replace missing meds for assisted self-administration meds and a patient pays directly for assisted self-administration meds. The OP's description implied that staff were administering the medications, not assisting with self-administration.

While it's certainly common for AL patients to receive their meds through assisted self-administration, it's not a firm rule. I've worked with a number of AL, ECF and SNF facilities on policy development, including med administration policies, and you'll find both types of med administration in all three facilities.

[onyx77]

That's true when assisting with self-administration, which is different from administering meds. You often can't use an e-kit to replace missing meds for assisted self-administration meds and a patient pays directly for assisted self-administration meds. The OP's description implied that staff were administering the medications, not assisting with self-administration.

While it's certainly common for AL patients to receive their meds through assisted self-administration, it's not a firm rule. I've worked with a number of AL, ECF and SNF facilities on policy development, including med administration policies, and you'll find both types of med administration in all three facilities.

Current regulations in my state do NOT allow for any type of e-kit in an AL facility. Period. Not even for those who have staff administer them. Residents who self-administer their meds take care of getting their own meds. Those that have staff administer receive their meds through the pharmacy the facility contracts with. The pharmacy bills the residents' insurance and the resident personally.

AL facilities and regulations are very different than those of a SNF. I have worked both and am VERY familiar with both as I work in a facility that has the full continuum of care.

SNF = e-kit/box, contingency.

AL = no e-kit, contingency. Hope your pharmacy can do a quick STAT run.

[BuckyBadgerRN, ASN, RN]

retracted

Actually this is incorrect. A resident in an AL (and LTC if not on a med a stay) privately pays for their meds. If staff is administering meds they are more than likely coming bubble packed and labeled for that individual. A pharmacy will not send the med without first billing the resident's insurance. The resident is responsible for any copays or whatever their plan does not cover. They personally receive this bill. Thus, borrowing from another resident is fraud/ stealing.

Another thing to add is that ALFs (not sure if its state specific or not) canNOT have an e-kit or contingency per regulations.

[Catch22Personified]

That's not uncommon in my experience at LTCs and ALFs. Sent from my iPhone using allnurses.com

Agreed. Narcs are still a problem in our facility for our knee replacement guys that come in at 1AM.