Pt diverting pain meds, managers aware, nothing is done!

[Peppermint_RN]

So frustrated right now! I witnessed a patient take his pain medication & a drink, and waited nearby (since we've had prior situations with this patient not taking the pain meds). I witnessed the patient take the pain meds out of their mouth & hide it under their sheet (they didn't realize I was watching). I am not allowed, per manage to, to confront the patient since they are a Veteran and I "will never win against a veteran".

This has happened numerous times with other patients, and when it is brought to the charge nurse, assistant manager then nurse manager, we are brushed aside and told pretty much there is nothing they can do since these patients are veterans! So I'm pretty much told to stand by & say nothing.

This is messed up & I do not feel the appropriate action is being taken!

[roser13, ASN, RN]

What do you think is happening to the meds? Usually the issue is patients asking for more, not less.

I guess I don't understand what upsets you about this situation.

[springchick1, ADN, RN]

How do you know they are diverting them and just not taking them? There is a difference.

[Jules A, MSN]

That would never fly with me. If they don't want to take them, no problem, I will take them back, thank you very much. I'm sure your management would be really thrilled by my requests for a mouth check if I felt a patient was attempting to cheek a med. Maybe its cause I'm in psych but medications that are not taken need to be destroyed. There is the concern that they are stock piling for intentional suicide, to get high which could result in unintentional OD, selling them which could result in someone else unintentional OD. I personally don't care if they are saving them to make earrings they are getting wasted or held if I attempt to give them and they are not immediately taken.

[Peppermint_RN]

We have found them before in the patients bedside table, about 6 pills that time. Patient denies spitting out the medications, but multiple nurses have witnessed the patient spitting them out then saving them. This patient gets very agitated if they are not given exactly on time as they are scheduled.

[roser13, ASN, RN]

We have found them before in the patients bedside table, about 6 pills that time. Patient denies spitting out the medications, but multiple nurses have witnessed the patient spitting them out then saving them. This patient gets very agitated if they are not given exactly on time as they are scheduled.

Again, why is this an issue? You can't call it diversion when the medication is not being sold or given to someone else. Surely there is no market for soiled (as in saliva) drugs?

[roser13, ASN, RN]

That would never fly with me. If they don't want to take them, no problem, I will take them back, thank you very much. I'm sure your management would be really thrilled by my requests for a mouth check if I felt a patient was attempting to cheek a med. Maybe its cause I'm in psych but medications that are not taken need to be destroyed. There is the concern that they are stock piling for intentional suicide, to get high which could result in unintentional OD, selling them which could result in someone else unintentional OD. I personally don't care if they are saving them to make earrings they are getting wasted or held if I attempt to give them and they are not immediately taken.

Ok, good points. I had not thought in those terms.

[Peppermint_RN]

That would never fly with me. If they don't want to take them, no problem, I will take them back, thank you very much. I'm sure your management would be really thrilled by my requests for a mouth check if I felt a patient was attempting to cheek a med. Maybe its cause I'm in psych but medications that are not taken need to be destroyed. There is the concern that they are stock piling for intentional suicide, to get high which could result in unintentional OD, selling them which could result in someone else unintentional OD. I personally don't care if they are saving them to make earrings they are getting wasted or held if I attempt to give them and they are not immediately taken.

My point exactly. I just don't know if I am held liable if something happens? I'm assuming if I document the incident and/or do an incident report, it is off my back? But the thing is, if something untoward happens to the patient and/or another person involved, it is on my conscience.

[Jules A, MSN]

My point exactly. I just don't know if I am held liable if something happens? I'm assuming if I document the incident and/or do an incident report, it is off my back? But the thing is, if something untoward happens to the patient and/or another person involved, it is on my conscience.

If you do what you are supposed to do it shouldn't really weigh on your conscience. What I most certainly would do is verbalize your concerns to management and document exactly what you said and were told to do regarding this situation. Consider the ramifications of this carefully before attempting but I have said something long the lines of "thank you for your help with this, I will document your recommendation". Interesting that sometimes that has changed the directive.

This is unsafe and vet or not I would use good nursing practice as well as documenting to cover your behind.

[nurseprnRN, BSN, RN]

Ask the physician to prescribe the med in liquid form. You can tell the patient that it will be more effective faster for his pain (this is actually true), since he needs to have it so promptly for relief. Give it to him, and a glass of water or juice as a chaser.

Vet or no vet, this is unsafe. If he collects a pile of those and ODs, and when (not if) it is found that more people knew about this, there'll be hell to pay, and your licensing board will wonder why you didn't think more of patient safety.

[dirtyhippiegirl, BSN, RN]

Again, why is this an issue? You can't call it diversion when the medication is not being sold or given to someone else. Surely there is no market for soiled (as in saliva) drugs?

There is a market for used fentanyl patches. I'm sure there is a market for soiled pills. People routinely inject drugs made from cleaning products into their veins with needles that have been used and re-used by random strangers. Why would there NOT be a market for this?

Although I would be more worried that he stockpiling to OD. We had a patient that was cheeking his PO meds, crushing them up, and shooting them into his IV when he thought nobody was looking.

[FineAgain]

Ask the physician to prescribe the med in liquid form. You can tell the patient that it will be more effective faster for his pain (this is actually true), since he needs to have it so promptly for relief. Give it to him, and a glass of water or juice as a chaser.

Oh they are way ahead of that. They pretend to swallow and spit it down the straw of the chaser and stockpile it that way. But it is easier to control this way, you just don't let them have a chaser that you aren't in control of.