Right thing to do or opening a can of worms?

[Longtrmrn52]

I work in a long term care facility and float. Was told in report that a patient had gotten 2 doses of pain meds during the previous shift. The narcotics were signed off in the narcotics book and count was correct. Patient complained of pain at the very beginning of shift. When I checked the MAR to see when he could get pain meds neither dose of the pain meds reported given were charted. I had experienced a decrepancy in the narcotic count with the same nurse previously. I found another discrepancy in what was charted on the MAR and signed out in the narcotic book. All were for the same drug and involved the same nurse. I reported this to the supervisor.

Now I don't know if I over reacted. It is easy to forget to sign or chart something. Have I made a bigger deal out of this and caused a co-worker a lot of grief for something trivial?

[Silverdragon102, BSN]

Could be a simple they didn't sign the chart but it could be something else and either way needs checking IMHO

[Magsulfate, BSN, RN]

If you reported it, then it is the manager's responsibility to check it out. Don't worry about what happens from there, you will not know what or if there is an investigation on the nurse. If this keeps happening, then keep reporting it.

[PMR1027]

I think you did the right thing. In our LTC/Rehab Facility, we had problems with a nurse abusing all kinds of opiates. Our suspicions started when entire supplies of non-narcotic meds were coming up missing, and patients were magically asking for all kinds of narcotics when she was working, when these patients were not taking them when any other nurse was working. This opened up a huge can of worms, but it is now going towards fixing several problems with medication administration in our facility.

[SuesquatchRN, BSN, RN]

I'd report it. We always counted together. Any discrepancy needs to be reported, if only to cover your own butt, let alone the the possibility that some poor resident's in pain because someone's gobbling his meds.

[heron, ASN, RN]

When you're charting the same dose in 2 or more places, it's easy to forget to do one of them. I think you did the right thing in reporting it because, whether the issue is poor pain control, poor charting or diversion, it needs to be addressed.

Run a search on addicted or impaired nurses and look through the threads talking about the damage done by active users, to themselves, their colleagues and their patients. Addressing this early could prevent serious harm.

Some have complained about being labelled unfairly as "impaired" and yes, this has happened. I think the key is to make your report then keep your eyes open and your mouth shut. Avoid the temptation to gossip about your suspicions.

I suspect that if your coworker is not using, then she'll take the questions as a wake-up call to tighten up her documentation.

If she is using, then she needs to be called on it asap, for everyone's safety.

[jackstem]

Many nurses don't realize that improper charting of controlled substances can bring board of nursing, pharmacy board, and DEA actions even though nothing was diverted. It's called Illegal Processing of Drug Documents and is a felony. I just read a blog about this, and according to the attorney who wrote it, more and more nurses are being investigated and prosecuted as part of a "get tough" war on drugs in some areas.

BE CAREFUL!!!

Jack