Question:
Dear Nancy,
A day nurse in the LTC facility where I work did not sign off an injectable drug for five days. Another nurse noticed the drug was still in the cart and saw the day nurse had not signed off the med sheet. The other nurse wrote a med error report as required by our protocol. Later, the second nurse found out the meds had been given, but the day nurse could not find the drug in the cart so she had taken another patient’s discontinued meds from the supervisor’s office. The patient did die in the hospital, but I’m not sure if the two events are connected. Is this a case of an RN dispensing?
Dear Nancy,
A day nurse in the LTC facility where I work did not sign off an injectable drug for five days. Another nurse noticed the drug was still in the cart and saw the day nurse had not signed off the med sheet. The other nurse wrote a med error report as required by our protocol. Later, the second nurse found out the meds had been given, but the day nurse could not find the drug in the cart so she had taken another patient’s discontinued meds from the supervisor’s office. The patient did die in the hospital, but I’m not sure if the two events are connected. Is this a case of an RN dispensing?
Melissa
Nancy Brent replies:
Dear Melissa,
It is unclear what has gone on in the scenario in your question. One thing that is clear, however, is using another patient’s medication that has been discontinued under any circumstances, including going into the supervisor's office and getting the medication, is a no-no for several reasons.
First of all, the question arises of whether this nurse had the authority to go into the supervisor’s office and to access any medication there. As you know, medications in long-term care must be under “lock and key” with only authorized people having access to the stored medications.
Second, a drug that is ordered for one resident cannot be used cavalierly for another. Is the medication that was used in the proper dose? Was the medication expired? Who will pay for the use of this drug because it had been discontinued for one patient but used for another? How did the nurse document the administration of the drug in the resident’s chart?
The “dispensing” concern is the least problematic issue in this scenario. Depending on your state’s definition of dispensing, the nurse also may have dispensed this medication.
It sounds as though the LTC facility may need to re-examine its pharmacy policies, especially when a supervisor is not present. Re-examination also is needed for the medication administration policy that hopefully would include a requirement the supervisor is called at home (if not on the premises) if such a situation arises so a lawful and well-thought-out solution takes place.
Dear Melissa,
It is unclear what has gone on in the scenario in your question. One thing that is clear, however, is using another patient’s medication that has been discontinued under any circumstances, including going into the supervisor's office and getting the medication, is a no-no for several reasons.
First of all, the question arises of whether this nurse had the authority to go into the supervisor’s office and to access any medication there. As you know, medications in long-term care must be under “lock and key” with only authorized people having access to the stored medications.
Second, a drug that is ordered for one resident cannot be used cavalierly for another. Is the medication that was used in the proper dose? Was the medication expired? Who will pay for the use of this drug because it had been discontinued for one patient but used for another? How did the nurse document the administration of the drug in the resident’s chart?
The “dispensing” concern is the least problematic issue in this scenario. Depending on your state’s definition of dispensing, the nurse also may have dispensed this medication.
It sounds as though the LTC facility may need to re-examine its pharmacy policies, especially when a supervisor is not present. Re-examination also is needed for the medication administration policy that hopefully would include a requirement the supervisor is called at home (if not on the premises) if such a situation arises so a lawful and well-thought-out solution takes place.
Cordially,
Nancy
Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.
