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

[Esme12, ASN, BSN, RN]

The OP sounds new to a management position and wants to do a good job. OP you have some QI issues here and need to formulate better processes.

OP you need to look at your policies. Look for a common place to put newly issued meds...a check in system so to speak so that all staff place them in the correct spot and the same spot every time.

The nurse who placed them in the inappropriate area needs to be spoken to as well. The nurse using the other patients drug...you now mention unlabeled and unsealed? Was this med just lying on a counter? How did she know it was the appropriate med? If it was labeled at all there is no med error here and the nurse was just trying to give the best care for the patient.

As the person in charge you need to come up with a system and make it policy on what to do in these situations. Maybe institute a med closet for supervision.

Situations like this are what we use for process improvement and QI. Get all of the staff on the same page by policy.

Make your expectations clear.

[imaro0m]

I didn't see any wrong action here

[kakamegamama]

Nurse Amy Jolie--Not an answer to your question, but instead an observation.....if your avatar is anywhere near your name, you probably want a less identifying one. You may have employees on this board, and discussion of workplace issues that you intend to be confidential or benign could become much more than that.

In response to your question, I'm in agreement with other responders. There should be a policy manual there that discusses such an issue. Plus, what are the Medicare, etc., laws that would govern this? Any violations that would put the agency and nurse at risk?

Hang in there--the learning curve will get easier along the way.

[chrisrn24]

1) get an e-kit

2) technically borrowing is wrong...it is "fraud." However that's not to say I haven't done it. When you're working NOCs calling the doctor to hold a med because it's missing is no fun. I think it's stupid we have to call for an order to hold in that instance but it's our policy.

3) I probably wouldn't have done it unless she was crawling off the walls but before that I would've called the pharmacy and yell at them.

[BlueLightRN]

I worked in a LTC ALF facility and had to do this a few times. D/C patients still had full vials of insulin in the fridge, unopened. Pharmacy wasn't delivering any meds for new admit for 10 more hours and the new admit needed insulin. I switched out the printed labels for the vials when the new one came in the morning so when meds did finally go back or were disposed the new vial was labelled for the d/c patient and the old vial was given to the admit. Yeah it can be dangerous if the med exposed the other patient to bacteria or something, and it could be fraud if you take and don't replace meds paid for by insurance mcare/mcaid for one patient and use them for another but the REAL problem here is that YOUR FACILITY LEAVES NURSES TO CARE FOR PATIENTS WITHOUT THE MEDS THE PATIENT NEEDS. It's not the nurse who needs disciplined here, it's you and your facility.

[klone, MSN, RN]

the REAL problem here is that YOUR FACILITY LEAVES NURSES TO CARE FOR PATIENTS WITHOUT THE MEDS THE PATIENT NEEDS. It's not the nurse who needs disciplined here, it's you and your facility.

They didn't, though. The first nurse put the meds in the wrong place.

[BlueLightRN]

Is there someone that the oncoming nurse can call to get new meds immediately? If not, then the nurse who left the meds elsewhere needs to be trained or disciplined, it's not the other nurse's fault.

[Marie-Aymee]

I know this was a common practice years ago. Here is a possible solution: Keep a small stock of commonly used meds on hand in a locked area (these should be checked every shift and counted just like narcotics are). This prevent a repeat of the current situation. Also, there would be a policy that the supervisor and or DON contacted in a situation such as this.

[BuckyBadgerRN, ASN, RN]

Are contingency supplies of "common" meds not standard practice? We have an insulin box filled with a vial or two of each variety of insulin, when you have to break into it, either for a new admit or because someone didn't order as they took the last one, you fax the sheet inside to pharmacy and they bring you a whole new box the next day. We also have a box in each med room with about 100 of the most common drugs we use, anti-hypertensives, diuretics, statins, etc for the same reason, new admits, a change in Rx, etc. Every Tuesday pharmacy brings an entire new box regardless of how much might have been used out of it. Same thing for narcs, we need a valid Rx, but then pharmacy gives us authorization to "break in" so residents have coverage of their narcotic pain medication or Ativan-type drugs while we wait for their full prescription to come from pharmacy. Borrowing from other residents is pretty much unheard of in our facility

[RNfaster]

They didn't, though. The first nurse put the meds in the wrong place.

But the facility and its systems clearly did not work. I agree with BlueLightRN that it's a system failure. Additionally, the facility should have contingency programs in place to handle misplacement/loss of meds ---such as an E-kit. What if a resident's last pill fell on the ground (there are other ways meds can be unavailable besides inadvertent misplacement of them by a worker). Wouldn't it be better to get them one from an e-kit and give it to them rather than not give it to them or give it to them from the floor?

[diazchris1124]

Hello Nurse Klone,

Thank you for setting some people straight. I agree with you as far as asking any question does not mean one does not know. A nurse should not be afraid to ask a question at all no matter what. As far as firing the nurse, I disagree. The Hospital policy should dictate if this action was correct or not. I can think of this practice becoming a nightmare for Pharmacy and reconciliation of medications. I think as a nurse with 39 years experience I would have waited for the Pharmacy to send up another dose. If you do not have a policy maybe your nurse can advocate and write one explaining how this practice can be dangerous and present it to your staff and the rest of the hospital. MCD

[ClearBlueOctoberSky]

Hello Nurse Klone Thank you for setting some people straight. I agree with you as far as asking any question does not mean one does not know. A nurse should not be afraid to ask a question at all no matter what. As far as firing the nurse, I disagree. The Hospital policy should dictate if this action was correct or not. I can think of this practice becoming a nightmare for Pharmacy and reconciliation of medications. I think as a nurse with 39 years experience I would have waited for the Pharmacy to send up another dose. If you do not have a policy maybe your nurse can advocate and write one explaining how this practice can be dangerous and present it to your staff and the rest of the hospital. MCD[/quote']

This is an ALF. Pharmacy is not readily available like it is in most hospitals. Shoot, where I work now, there are multiple issues with our pharmacy. Sometimes we are lucky to get our stat meds delivered to us within a four hour window.