Write up for patient pocketing pills

Nurses Medications

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Hi all,

TL;Dr I'm being written up because a patient pocketed a pill, am I at fault for a patient being deceptive?

I'm writing because I'm stressed and I'm not sure if I'm in the wrong. I'm being written up for a narcotic found at patients bedside.

A relatively young and homeless patient came under my care in telemetry for cellulitis. UA came back negative for all except THC. Although twice through my shift the patient asked for norco, he did not seem to be drug seeking or requesting pain meds around the clock. AOx4, swallowed fine.

A few days after caring for him, it was brought to my attention (on my day off) that he was found to have one norco at bedside shortly after my shift by the AM nurse - I was the last one to administer the narcotic. Legal, pharmacy, and mgmt were brought in.

The patient was apparently kinda vague and inconsistent with his story. But said that he had gotten the pill at night, that he had changed his mind about taking it, that he had dropped it, and that the nurse was unaware that he hadn't taken it.

Being there, I specifically remember handing him his medication and watching it go to his mouth - which is what I told mgmt. Did I check his mouth with a pen light? No. Did I have reason to believe he was a drug seeker or at risk of self medicating, no. His UA was negative and he was in legitimate pain when asking for his meds.

Am I at fault for a patient being deceptive? Is it fair I'm being written up?

Im being defensive, but I'm very frustrated that 1. They trust the patients word over mine, and 2. My supervisor told me that I should have checked him with a pen light after watching it put to his mouth - as if that's standard routine for drug administration.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

I work in psych where patients do sometimes cheek meds. But even in psych, we don't check the mouth unless the patient has a history of cheeking meds, or there is some other clinical reason to do it.

You didn't have a clinical reason to check the mouth. And to do so on every patient is not only a waste of time, but also paternalistic and unfair to the patient.

The fact that the patient is homeless and tested positive for THC is not a reason to mouth check. To suggest otherwise is to perpetuate stigma.

From this point forward though, you have a reason to do a mouth check on this patient, so do it. Just don't let anyone tell you that you should have known this beforehand.

And if administration habitually nitpicks you then move on.

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On 6/30/2020 at 5:16 AM, AnObviousThrowAway said:

I'm writing because I'm stressed and I'm not sure if I'm in the wrong. I'm being written up for a narcotic found at patients bedside.

I mean this kindly: You need to learn pleasant assertiveness, and fast. Actually, in this case, "business assertiveness," which is more "assertiveness" and less "pleasant."

There is no way in hell I would tolerate this treatment. I wouldn't even entertain it. I would say something along the lines, "No pill was left at the bedside. It was administered according to policy and nursing standards. We're done here."

I would write the same on the signature line of the write-up.

Then promptly find another job. Hopefully this is what you are busy doing right now.

I'm sorry you were treated this way.

Illogical unfairness like this should put you into business mode, instead of questioning whether these nefarious game-players have a point.

Nurses need to stop this; stop acting and reacting this way.

Find new job. Use this lesson going forward (not about pills but about how to handle poor treatment of nurses). Best wishes to you ~ ??

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On 6/30/2020 at 5:16 AM, AnObviousThrowAway said:

UA came back negative for all except THC.

On 6/30/2020 at 5:16 AM, AnObviousThrowAway said:

did not seem to be drug seeking or requesting pain meds around the clock

On 6/30/2020 at 5:16 AM, AnObviousThrowAway said:

Being there, I specifically remember handing him his medication and watching it go to his mouth - which is what I told mgmt. Did I check his mouth with a pen light? No. Did I have reason to believe he was a drug seeker or at risk of self medicating, no. His UA was negative and he was in legitimate pain when asking for his meds.

Literally every bit of the above is completely irrelevant.

On 6/30/2020 at 5:16 AM, AnObviousThrowAway said:

I was the last one to administer the narcotic.

Especially to this point: Who cares!! That proves absolutely nothing. If they guy was found with a pill that no one thought he had, it could have been from anyone/any time. Even from the street for that matter. But, even if it was from the hospital there's no reason it could only be from the most recent dose administered.

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Specializes in retired LTC.

JKL33 -great response.

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Specializes in oncology.

Jeepers, throughout the 40 years of nursing I have found quite a few medications in the bed when I boosted patients up. I have found medications at the bedside such as a swish/spit or swish/swallow including nystatin. Now it does mess up the q 4 hour schedule but besides seeing the patient put the med in their mouth what more can you do on a regular floor? We are dealing with adults and they sometimes need a little control in their hospital life.

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On 7/4/2020 at 4:48 PM, JKL33 said:

I mean this kindly: You need to learn pleasant assertiveness, and fast. Actually, in this case, "business assertiveness," which is more "assertiveness" and less "pleasant."

There is no way in hell I would tolerate this treatment. I wouldn't even entertain it. I would say something along the lines, "No pill was left at the bedside. It was administered according to policy and nursing standards. We're done here."

I would write the same on the signature line of the write-up.

Then promptly find another job. Hopefully this is what you are busy doing right now.

I'm sorry you were treated this way.

Illogical unfairness like this should put you into business mode, instead of questioning whether these nefarious game-players have a point.

Nurses need to stop this; stop acting and reacting this way.

Find new job. Use this lesson going forward (not about pills but about how to handle poor treatment of nurses). Best wishes to you ~ ??

Best advice I have heard in a LONG time! Thank you! I have not had this exact situation happen to me, but have had a few similarly nit picky, vague things happen in my 36 year career and I have always reacted like a timid little fearful caught in the headlights creature, I am sorry to say. Good lord, how many pills have I found over the years in a patient's linen or on their bedside table? I just threw them out and went on, never occured to me to try to launch a full on investigation. But when it happened to me, I was fearful and timid and apologetic even if I was fairly certain I was not guilty of anything. You are right and you have given me courage! I think you said it all when you said, "Nurses need to stop acting this way." We need to be firm and sure of ourselves. I cannot believe this above incident even became a thing!

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6 minutes ago, LynnRN53 said:

You are right and you have given me courage!

Awesome! That makes me happy. It isn't just talk, either. Not narcotics, but I've been approached a few times in my career with utter BS like this and I certainly did respond just the way I advised above. A funny thing about that is that when you use "business mode" sparingly and always appropriately (I.e. don't just go off about every little thing), it protects you in the moment and also decreases future incidents (I assume...since I haven't had many). To a large extent, we are the ones who teach other people how they can treat us.

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WELL SAID! I am going to suggest you try submitting some articles to nursing journals, you write as well as you think and reason! Yes, yes, yes...we do teach others how to treat us. This reminds me....2 1/2 years ago I auditioned for a Christmas show at a local very popular community theatre. Hadn't been on stage for 40 years! Got the part! I started off with the other actors confidentally but somehow I started letting my insecurities slip in and started behaving less so, and some of the other actors began to talk to me and treat me differently. An argument could be made, I guess, for their not being terribly nice folks in the first place, to treat me that way, but I have to talk responsibility for teaching them to treat me that way, a painful lesson that has stuck with me! Thank you again!

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