Misappropriation of Resident's Narcotic Medication by Staff
Penalty
Summary
A deficiency occurred when a nurse (RN) repeatedly signed out and documented the administration of Norco, a narcotic pain medication, for a resident who did not actually receive the medication. The resident, who was cognitively intact, alert, oriented, and a retired RN, consistently reported that she only took Norco at night to help her sleep and never during the day. Despite this, the narcotic count sheets showed that the RN signed out Norco for the resident on multiple occasions during daytime hours, often one tablet at a time, while the resident's order was for two tablets every six hours as needed for pain. The Medication Administration Record (MAR) did not reflect these daytime administrations, and the resident confirmed she had not received the medication during those times. Interviews with staff, including the DON and other nurses, confirmed that the facility's policy required all administered medications, especially PRN narcotics, to be documented both on the narcotic sheet and in the electronic MAR. If a medication was not documented in the MAR, it was considered not administered. The discrepancy was identified when another nurse noticed inconsistencies between the narcotic count sheet, the resident's order, and the MAR. The resident was able to identify her medications and was aware of what she had taken, further supporting that the narcotics were not administered as documented by the RN. The facility's policies also required a narcotic count at each shift change, with both off-going and on-coming nurses signing the count sheet. Despite these procedures, the RN continued to sign out and document the removal of Norco without actual administration to the resident, resulting in the misappropriation of the resident's medication. The resident's rights policy specifically stated that residents have the right to be free from misappropriation of property, which was not upheld in this instance.