What to do? Very likely family using, selling, etc pt's meds

[NurseG77]

What do you do when you highly suspect a family member is either selling, taking, or both a pt's medication? I have addressed this with my supervisor, but all I get is the run around. Long story short for you all. Have had pt for approx 3 months. Perform med check q weekly to week and a half.

Approximately 2 weeks ago, discovered an empty bottle of oxycodone 30 mgs 3X daily. Said to pt, "Oxycodone? I didn't know you were on oxycodone. Where did this come from?" With a blank stare into space, he said, "I don't know." I said, "You don't know." He said, "No, I don't know." This script was filled not too long ago. All of his meds are always in his lock box. So, all of a sudden out-of-the-blue, there is this empty bottle of this med.

His other nurse who works for a different agency said he has to go in monthly to get this script refilled. This nurse also told me that it is known to her that this family is known to be into drugs.

I have called his MD, but have yet to get a call back. He is on morphine sulfate as well. If I ask the doctor to do a urine drug screen will this detect if he takes the oxy or not? Some of his med counts are off as well. I highly suspect his son is the one doing this and that the pt may be aware of it. What should I do?

Thank you,

NurseG

[caliotter3]

I would send a written report to the patient's doctor and request to be removed from the case. You could make a report to the local law enforcement authorities, but it is my understanding that they do not get involved in such matters. Still, if you had your copy of the written complaint you send to the police, then no one could come back at you with accusations. Stealing the patient's drugs or using him to obtain drugs illegally is a form of abuse of a vulnerable person (assumed); so you want to protect yourself by reporting. Insure your agency supervisor has received a written report so you have another paper in the trail. You will probably have to find another job if your agency is going to take this kind of a "don't see anything wrong" attitude. Protect yourself as well as the patient's interests.

[NurseG77]

Thank you, Caliotter3. I will write the doctor a report and send it where he has to sign for it and where I get a return receipt. I called the board of nursing in my area (FL) and they told me to fill out a form online, but the site they sent me to doesn't seem like the right form for me. I will have to call them again. Yes, this pt is vulnerable as he has a spinal cord injury.

[rn/writer, RN]

In many states you can anonymously report the abuse of a vulnerable patient, especially if they are older. It might be better to do it out in the open, but as caliotter said, you'll probably end up looking for a new job.

Thank you for not just looking the other way in this situation.

[NurseG77]

Well, I am making preparation for the separation from the agency if you know what I mean. I do know for a fact the script is being filled per pharmacy. This pt is not older. So, I should make a report to adult services as well I suppose. This is terrible. I am a new nurse. What an introduction! I still love home health, though.

[caliotter3]

The patient does not have to be elderly to qualify for mandatory reporting, just vulnerable, helpless. In this case he is because he is paralyzed. Definitely calls for a report. And I would look for employment elsewhere. The agency will most likely make things miserable for you, if they don't terminate you outright. Get ready for the long haul and good luck finding another job.

[carwin]

The MSW needed to have been called in on this case. This has become a social issue. That's what they do. Notify the MD of your suspicions. Get the MSW order. The MD can drug test, usually a blood draw so that the blood can be taken along with a CBC to not make the patient suspicious. Let the supervisor know. Document what steps you've taken. The MSW knows the questions to ask-is there an addiction that pt or family member needs to treat or do you think your kid is taking you meds or selling. If someone seems to be keeping meds away-whether they are taking them or not, APS is to be summonedm

[NurseG77]

The MSW needed to have been called in on this case. This has become a social issue. That's what they do. Notify the MD of your suspicions. Get the MSW order. The MD can drug test, usually a blood draw so that the blood can be taken along with a CBC to not make the patient suspicious. Let the supervisor know. Document what steps you've taken. The MSW knows the questions to ask-is there an addiction that pt or family member needs to treat or do you think your kid is taking you meds or selling. If someone seems to be keeping meds away-whether they are taking them or not, APS is to be summonedm

Yes, I have requested twice to my supervisor that a social worker be brought out to the home, but pretty much got the run around again or I really guess I should say no reply related directly to my request. She said she would send out another staff member whom I have never heard of before. I am thinking this lady is no social worker.

Tomorrow I am contacting APS, the MD via certified mail, and I am on the fence about the cops. Do you all think I should do that, too? The morphine count was off significantly yesterday (there was 1 tab left) and there has been no valium in sight lately. This morning I woke up and the first thing I thought about was my pt suffering in pain because he is going to be out of morphine. Maybe he will make another trip to the ER like he did a few weeks ago.

Thank you,

Nurse G

[caliotter3]

If you notify the police you will have covered all of your bases. Suggest you do it in writing via a written report given to the desk sergeant and keep a copy for yourself. They will give you a copy of a form or card that will give you the case number of your report. Then, in the future, if this should come back to haunt you, copies of all of these written reports to everyone concerned will be proof that you complied with mandatory reporting. Good luck on the job search.

[NurseG77]

Ok. Now, should I notify my supervisor about what I am doing or no? My mom thinks I shouldn't. She said it is none of my supervisor's business. She said if I do to let her know I am covering my buttocks and looking out for my pt, which is my responsibility.

Nurse G

[caliotter3]

You have already notified your supervisor. Doing so now will only bring the end of your job closer and make things uncomfortable for your sooner rather than later. Your supervisor has been told what she needs to know. She will find out about this soon enough. Hopefully you will have already resigned.

[Jolie, BSN]

I am asking this question of experienced home health nurses simply for my information only. I have no experience in home health and have never had to make a report directly to law enforcement in any practice setting, so I'm curious:

In this case, I fully understand and agree with contacting the physician and APS to report suspected abuse of a vulnerable adult and suspected diversion of narcotics.

I'm less certain of making a police report without having hard evidence of the drug diversion, such as witnessing a family member taking the medication or the patient stating that it happened.

Can you share your decision making process with me as to why you believe a police report to be necessary? Would follow up of the missing drug not occur with the APS report? Are you suggesting making the police report as a means of protecting the nurse from accusation?

Just curious as to the rationale and whether making a police report potentially raises any liability (such as libel, defamation of character or HIPAA violation) if no evidence is found against the family which supports the accusation.

Thanks!