Misappropriation of Resident's Controlled Medications by LPN
Penalty
Summary
Facility staff failed to prevent the misappropriation of a resident's controlled medications when an LPN removed and failed to account for a significant quantity of Oxycodone and Lorazepam. The resident, who was assessed as cognitively intact and experiencing chronic pain with an intensity level of seven, had an active order for Oxycodone-Acetaminophen but no documented order for Lorazepam. Pharmacy records indicated that 120 tablets of Oxycodone were delivered, and upon discharge, staff documented releasing 49 tablets of Oxycodone and 25 tablets of Lorazepam to the resident. Subsequent investigation revealed discrepancies in the medication count and missing medications after the resident's discharge. Video footage showed the LPN removing three medication cards from a locked narcotic box, placing them in the medication cart, and then leaving the medication room with a full card and the medication sign-out sheet. The LPN was later observed disposing of items in a shred bin and trash, which were later identified as the top of the medication card and an empty medication card, respectively. The incident was brought to the facility's attention when the resident's spouse reported missing medications. The DON and administrator reviewed the video footage and confirmed the LPN's actions, which were also documented in a police report. The facility's policy clearly prohibits misappropriation of resident property, including medications, and directs staff to protect residents from such actions by anyone, including facility staff.