not signing prn narcotics out on the MAR

[ellehagewood]

Does anyone know if there is information in writing that states when a nurse signs prn narcotics out on the narcotic sheet but fails to sign the medication out on the MAR and/or document why the prn narcotic was administered is a form of diversion? In this situation, the nurse is doing this with multiple prn narcotics and sometimes they sign and document the prn medication as administered on the MAR and other times the prn narcotic is only signed for on the narcotic count sheet. This came to our attention because the nurse administers prn narcotics often and more frequently than any of the other nurses. We want to make sure to do what is legally correct and make sure if they are diverting narcotics that they have help if they want it.

[classicdame, MSN, EdD]

recommend checking your BON and facility policy and pharmacy (ISMP has standards regarding medication administration).

[Esme12, ASN, BSN, RN]

Failure to document properly is reportable. I'd call the BON and check with you manager/HR. I would not however discuss this on social media.

[Meriwhen, ASN, BSN, MSN, RN]

Failing to sign out a PRN narcotic on the MAR, by itself, is not automatically prima facie proof of diversion. Otherwise every rushed nurse who forgot to chart one PRN Tylenol 3 or Ativan would be strung up on diversion charges.

That being said, if you strongly suspect that this nurse is diverting, her charting--or lack thereof in this case--is one of many factors that should be examined. Such other factors would be how long this has been going on, what medication(s) tend to be unaccounted for, the nurse's behavior at work (is she clearly impaired, loads of sick days taken, willingness to work extra as much as possible) and so on...

As Esme said, improper documentation of narcotics is reportable. I agree with the prior posters. Talk to your facility's administration and cease discussing this online. If you are unsure about the legality of the nurse's charting, you should contact your facility's legal department. And I am not implying anything, but if you are the nurse in question, you should consult a lawyer ASAP.

Best of luck.

[ellehagewood]

I am trying to find this information for a fellow nurse manager. I want to provide her with tools and resources she can use for this situation. This is not a facility I manage at or a nurse that I manage. Thanks for the information.