Misappropriation of Resident Controlled Medications by LPN
Penalty
Summary
The facility failed to protect residents from the misappropriation of their property, specifically controlled medications, as evidenced by discrepancies in medication administration and documentation for 16 residents. Facility records, including narcotic count sheets and medication administration records (MARs), revealed that an LPN removed and signed out controlled substances such as alprazolam, oxycodone, tramadol, and lorazepam in quantities that did not match what was documented as administered to residents. In several cases, medications were signed out but not recorded as given, or the number of doses removed exceeded those documented as administered, indicating probable diversion of medications. Witness statements and facility documentation indicated that the LPN in question was observed removing medications inappropriately and appeared impaired while on duty. The discrepancies were identified during a narcotic count and review of the MARs, which showed multiple instances where medications were either not given as ordered, not documented correctly, or removed without proper documentation. The issue was reported to facility leadership, and law enforcement was involved after the LPN was found to be impaired and refused a urine test. The affected residents had orders for various controlled medications for pain and anxiety, with specific dosing instructions. The clinical records and narcotic count sheets for these residents showed multiple inconsistencies, such as medications being signed out but not administered, doses given at incorrect intervals, and conflicting documentation between the narcotic sheets and MARs. These actions resulted in the wrongful use of residents' medications without their consent, constituting misappropriation of resident property.