Two weeks after an LPN worked a night shift, she was informed by the director of nursing that there was a discrepancy with the narcotic medication count. The LPN insisted the count was right when she finished her shift.
The facility investigated, after which the LPN was informed that the roommate of the patient, whose particular narcotic was supposedly missing a dose, said he saw the LPN give medications to the patient that night. The LPN, who works for an agency, said the facility closed the investigation, apparently without any charges by the facility or by the LPN's agency. However, the state's department of public health was called to investigate the discrepancy. The LPN wonders what she should do and what might happen to her.
What can happen
In this case, the LPN is at an immense disadvantage because she was the only one on staff who counted the narcotics before she left the facility. This approach is inconsistent with best practices that require two people conduct the count, with at least one being licensed, such as an LPN, RN, or APRN.
Requiring two people to conduct the count reduces the chances -- as much as humanly possible -- of an incorrect count and provides a legal witness of the medication count. The two staff members counting the narcotics are held legally liable for accurately performing the count and bear potential responsibility for any discrepancy. In the LPN's case, she is the only licensed individual who can attest that the count was accurate.
This situation raises questions, including:
- What did the facility's investigation involve?
- Did the LPN follow the facility's policies on narcotic medication administration, such as ensuring that the key to the narcotics cabinet was only in her possession while she was on duty?
- Did she personally give the key to the day staff nurse who should've received it?
Another unanswered question is how the state department of public health became involved in this matter. Generally, a complaint can be filed by a patient or patients, a caregiver, nursing staff, or a patient's family member. The complainant is confidential.
Since it closed the investigation, it doesn't seem likely that the facility reported the error, unless it's mandated to do so under the state's regulations. Regardless, the department of health became involved.
What should the LPN do now?
The LPN should retain a nurse attorney or attorney as soon as possible and certainly before she contacts either the facility or the department of public health.
There is no doubt that the LPN faces potential legal obstacles in this situation because:
- There is no one to support her position that the count was correct when she left.
- There appears to be no other "suspect" to investigate.
- If the department of public health believes she diverted the narcotic, she will be reported to the state board of nursing for investigation and possible disciplinary action.
Hopefully, the LPN's statement that the count was correct will be proven true by all parties. If it is, this situation will have a happy ending. Even if that is the end result, she first must get through the arduous steps ahead.
What you can learn from this situation
Although this particular case involves an LPN, all nurses should keep these lessons in mind.
- Always follow your facility's policy for manually counting narcotics, both at the end of your shift and if you are required to sign off on narcotics delivered to you by an in-house or external pharmacy.
- Always have a witness to your end-of-shift medication count or narcotics acceptance from the pharmacy -- whether your facility's policy requires it or not.
- Never lend the key to your narcotics storage area to another staff member or leave it in an unsecured location.
- If there is a discrepancy in the narcotics count when you come on duty, notify the unit manager and/or the director of nursing, and file an incident report as required by your facility's policy.
- Retain a nurse attorney or attorney immediately if you are notified that you are under investigation for missing narcotics.
- Document all medications you administer during your shift on patients' medication administration records and in nursing notes.
- With your attorney's guidance, cooperate with any investigation(s).
- If you're faced with a state board of nursing disciplinary proceeding, always retain a nurse attorney or attorney to represent you.
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