Failure to Remove Nurse During Medication Misappropriation Investigation
Penalty
Summary
The facility failed to prevent further potential medication misappropriation by allowing a nurse to continue working during an active investigation into missing narcotic medication. According to facility policy, any employee accused of resident abuse or misappropriation is to be placed on leave with no resident contact until the investigation is complete. However, after a 30-count card of Hydrocodone was reported missing for a resident, the nurse responsible for the medication cart was not removed from duty. She admitted to leaving the medication cart keys unattended on multiple occasions during her shift, and the missing medication was reported in the afternoon. Despite this, she continued to complete her assignment, including medication passes, and was not instructed to turn in her keys or leave the facility during the investigation. Interviews with facility administration confirmed that the nurse remained on duty and maintained access to the medication cart throughout her shift and the subsequent shift, even after the missing medication was reported. The police were notified and responded to the incident, and the nurse was drug tested but allowed to return to her duties. Review of time cards and controlled drug count records corroborated that the nurse was present and responsible for the medication cart during the period in question. The facility acknowledged that it did not follow its own policy to prevent further potential misappropriation by not removing the nurse from resident care during the investigation.