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!

[AuDDoc]

OK you said veteran so I am assuming you are in a VA facility.

E-mail your nurse manager and tell them what is going on. Documentation documentation documentation. If it's not documented then it did not happen. I would document it in his note that you witnessed him remove the pain pill after it was given and hide it. It doesn't matter if he is selling it or just not taking it, he is not using his prescribed medication correctly. The DEA is not going to care either way if something happens and nothing was done.

I would go to your union as well and file a complaint if nothing is done.

If nothing is done then you report it to the director of the facility. If nothing is done then it's time to go higher up and notify the national whistleblower line.

This is a safety issue and you are a witness to it. Report it. If it's not fixed and something happens and they find out you knew about it trust me the crap rolls downhill and you will be held responsible for it.

[BittyBabyGrower, MSN, RN]

Write it up and report it. My dad was hiding pills when he was in LTC, it was when he was found slumped over his bedside table and I found a pile of pills in his bedside drawer did it dawn on me he took a deliberate OD. He was end stage COPD and had several PRN mess, which he would ask for and then hide it in a box in his bedside table. I later found out that a few nurses suspected he was hoarding them. I turned them into the state.

Don't be that nurse that doesn't say anything. They were all investigated by the BON.

[flyersfan88]

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?

I wish I was this naive. You are sorely mistaken. People who want pills will take whatever they can get.

We had a patient that did this. We look away his pills. End of problem.

[Dranger]

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.

I have seen two 20 something IVDUs do this, both got fungemia and died. Great decisions people great decisions.

[rnICU303, BSN, CNA, RN]

OP, I strongly encourage you to protect yourself in this situation. Nobody else is going to. For starters meds are given per protocol, so if you witness your patient not taking them you need to take them back and waste them appropriately, otherwise you are at fault for not following protocol. The patient has a choice he can take them and swallow them (try crushing in applesauce) or you take them back and waste them. That is it. You can not get in trouble in this situation for following policy.

As other nurses have mentioned, I have seen patients die from diverting pills then crushing them and then 'shooting' the liquid into their own PICC lines or IV's, I also witnessed a case where a young boy in psych hid pills in a hole in ihs mattress and then took them at all once and died also.

If you are following the rules of medication administration you will not be found at fault later down the line if or when this all comes out. Other nurses including managers and administration who failed to act will be. Do not put yourself at risk, along with the career you have worked so hard for.

[rnICU303, BSN, CNA, 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?

It is a major issue on so many levels. The biggest one being the nurses who are witnessing this are not following policy regarding medication administration and therefore putting their asses (licenses) on the line in the event of an adverse outcome.

[Fiona59]

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, trust me. We have an issue this right now. Pouches, leaves the unit and sells outside.

We got an order to crush the meds and give in apple sauce. One very ticked off abuser

[Jules A, MSN]

It is a major issue on so many levels. The biggest one being the nurses who are witnessing this are not following policy regarding medication administration and therefore putting their asses (licenses) on the line in the event of an adverse outcome.

And I guarantee the managers, administrators or whoever said let them do whatever they want because they are a vet will disappear, lie or don't have licenses that can be taken when the bell tolls.

[annabanana2]

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?

Surely there is no market for soiled drugs? Oh man. I wish. I have clients that will swallow their methadone at the pharmacy (which is a liquid, by the way, and witnessed ingestion) then go back out onto the street, vomit it up and sell it to someone else who then will swallow it. Same with pills.

[BuckyBadgerRN, ASN, RN]

My name isn't Webster, but I'm not sure diversion is the term you're looking for if it's the patient's own med. I also don't get the "you'll never win against a vet" statement---are we at war here at home?

Have you tried TALKING to the patients in a non-accusatory manner? Maybe find out WHY they do what you're saying they do?

[Jules A, MSN]

I also don't get the "you'll never win against a vet" statement---are we at war here at home?

No but I have definitely seen the overall climate at civilian hospitals include treading lightly around veterans especially considering the egregious medication regimens they often come in with which often include stimulants, benzodiazepines and opiates. I have mixed feelings about it and tend to make med changes based on what I know to be safe and current however I agree it doesn't look good for anyone to have a veteran complain about their treatment.

[Tenebrae, BSN, RN]

A note with the documentation. Ensure that you document specifics. Eg if your manager states "theres nothing we can do, mr X is a vet" document that "This was reported to *name* who advised that there was nothing that could be done Mr X is a vet"

I've seen it happen before where nurses are told things by management and when it all goes to brown stuff the manager will turn around around and say "I never said that"