Misappropriation of Resident Narcotic Medication
Penalty
Summary
The facility failed to protect a resident from misappropriation of property when a card of oxycodone and its corresponding narcotic log sheet went missing from the medication supply. RN 2 reported that during the narcotic count at 10:00 p.m., there were two narcotic cards and log sheets for the resident’s oxycodone. When RN 2 returned for her next shift at 6:00 a.m. and completed another narcotic count with RN 3, one oxycodone card and its narcotic log sheet for the resident were no longer present. RN 3 stated that the resident had required pain medication during the night and then left the facility without signing to indicate the narcotic count was completed and accurate. The DON’s review confirmed that the medication card and documentation sheet for the resident’s oxycodone were missing, with only the top of the narcotic card found in the medication disposal box and no pills present. The pharmacy verified that a card containing five oxycodone tablets for the resident was missing. The resident, who had diagnoses including diabetes mellitus, a fracture of the lower end of the left femur, chronic kidney disease, and non-traumatic subarachnoid hemorrhage, had an order for oxycodone HCL IR 5 mg every 6 hours as needed for pain and reported not being aware of the missing medications or recalling receiving a pain pill at 2:00 a.m. on the date in question. These findings supported that the resident’s narcotic medications were not kept free from potential theft or wrongful use by an employee.
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