Nurse stealing narcs advice

[Nursenicole1]

I have a dilemma I have been facing at work for sometime now. There is one nurse who gives out WAY more pain medication then any other nurse. It has always seemed weird to me but now alert and oriented patient are telling me they are not getting their pain medication when she is saying she is given them. Also this nurse will give more than what's prescribed if it's one every 8 hours PRN she will give one at 715 and 245 (shift is from 7-3). I have went to my DON multiple times about this and she said she did an investigation but nothing has happened no days off or anything. At the very least she making regular med errors (literally everyday she works) with giving them to frequently. But I know she is always taking them as well. I don't know what I should do. Should I go above my DON so something gets done about it? If so who do I report it to and is there anyway to do it anonymously?

[zzbxdo]

I work in a burn unit. Our a&o patients often recieved oxy q4hrs or even more frequently, with prn breakthrough iv, and additional prn iv + po for wound care, and scheduled oxycontin. These patients still co pain 10/10 even at rest. You've reported it, set it and forget it.

[floridaRN38]

If the pts are complaining they did not receive there pain medication u did right by reporting it.

Also if pts are asking and not receiving from this nurse and the pt is telling u this. U can have the pt talk to supervisor that it is happening. Have the pt report it. I remember when my dad was in a rehab for a hip fx even though he was 90 years old he also was SHARP. AAO*4. He was in pain. He also was the type to not take pain meds unless he really was In terrible pain Tough guy. BUT in this rehab when I went to visit him he said he was in so much pain while sitting up in a w/c. Also he was very diaphoretic. He said he hurt so much. I asked him if he received his Percocet 5 mg he said no. So I went to the nurse and asked about it. She said he took it an hour ago. I think she was full of it. It is scary what we see as a nurse when on the other side. [emoji17]

[CelticGoddess, BSN, RN]

I don't think the hour before and after applies to PRNs...

It has at the facilities I have worked at. Unless there is policy that states otherwise for PRN, they are included in the hour before rule. If a patient is on Q8prns, I'll give it early if they need it.

[hppygr8ful, ASN, RN, EMT-I]

I don't think the hour before and after applies to PRNs...

Yes the hour before rule does apply to PRNs and can be given - It is so stated in the JACHO and CMS guidelines.

Hppy

[hppygr8ful, ASN, RN, EMT-I]

PS> If I had a patent in pain and shift change was a 3 pm ( which is it is my facility where we work 8 hour shifts) and I had a patient in pain I would not hesitate to give a Q 8 PRN that was due at 3pm at 2:45. Especially since I know full well that the patient the patient probably won't me medicated by the next shift until close to 4 pm.

[Jensmom7, BSN, RN]

I don't think the hour before and after applies to PRNs...

Yes. It does.

[Ackeem, BSN, MSN, RN, APRN]

You stated you know shes taking the drugs, perhaps you could expound on that statement more or is this pure conjecture on your part.

[NotAllWhoWandeRN, ASN, RN]

This. The NM cannot and should not share the results of an ongoing investigation with the nurse in question's colleagues.

Giving q 8hr pain meds at 7:15 and 2:45 isn't a med error.

[Edited to add: I thought someone was saying it was given at 6 hours instead of 8. Clearly giving an 8 hour PRN at 7.5 hours is not a problem.]

Really? My first hospital job had a clearly outlined PRN policy that said you could give them no more than 30 minutes prior to the interval mark. So if a med was q 8, it was a med error if you gave it befor 7.5 hours had passed. The places I've worked since then haven't been able to give me a clearly defined policy (which squicks me out; I like to know policies so I can stay in line) so I've stuck with 30 minutes. If you allow a full two hours of leeway, a 4 hour PRN could be given q 2.

The suggestion of incident reports sounds good. That way you're creating documentation, which I'm sure they'll need if they are continuing to investigate. They may need to give this nurse more rope with which to hang herself.

[Ruby Vee, BSN]

If the pts are complaining they did not receive there pain medication u did right by reporting it.

Also if pts are asking and not receiving from this nurse and the pt is telling u this. U can have the pt talk to supervisor that it is happening. Have the pt report it. I remember when my dad was in a rehab for a hip fx even though he was 90 years old he also was SHARP. AAO*4. He was in pain. He also was the type to not take pain meds unless he really was In terrible pain Tough guy. BUT in this rehab when I went to visit him he said he was in so much pain while sitting up in a w/c. Also he was very diaphoretic. He said he hurt so much. I asked him if he received his Percocet 5 mg he said no. So I went to the nurse and asked about it. She said he took it an hour ago. I think she was full of it. It is scary what we see as a nurse when on the other side. [emoji17]

What's a "pt"? What's a "u"?

Seriously, you can type out "supervisor" but not "you"? What's "AAO"? Text speak is against the terms of service, and besides that it's just rude and unprofessional.

And disrespecting a fellow nurse without knowing a thing about the situation other than what your 90 year old father told you? One Percocet may not have been enough for his pain, perhaps he needed two. Maybe he needed Dilaudid. Maybe he got it and forgot it. You weren't there and you don't know.

I've been a patient or the family member of a patient all too often in the past ten years. Maybe I'm just lucky, but I've only encountered one nurse that scared me. She was on orientation and her preceptor promptly set her straight.

[NotAllWhoWandeRN, ASN, RN]

I don't see any facts in the original post -- except the 7:15 and 2:45 times which seem pretty sensible to me. Are you sure your concern is narcotic diversion or potential narcotic use rather than getting someone into trouble?

I didn't bother doing the math before, but that's 7.5 hours. That's perfectly reasonable on an 8 hour PRN. The issue of the patient claiming they didn't get a documented med is a different problem, but is it only one patient? What brought this nurse to your attention? Do you regularly check when meds were given during other shifts? Is it possible this one patient is being malicious?

[NotAllWhoWandeRN, ASN, RN]

Yes. It does.

That depends on facility policy.

[NotAllWhoWandeRN, ASN, RN]

Yes the hour before rule does apply to PRNs and can be given - It is so stated in the JACHO and CMS guidelines.

Hppy

I didn't know that! Thanks for sharing; I'll have to go dig that up.