LPN is suspected when medication counts are low

The facility conducted an investigation, and the LPN was informed that the roommate of the patient, who was allegedly missing a dose of a specific narcotic, reported that he had seen the LPN administering the patient’s medications that night. The LPN, who works for the agency, stated that the power closed its investigation, apparently with none charges being filed by either the power or the LPN agency. However, the state public health department was called in to research the discrepancies. The LPN wonders what she should do and what might occur to her.

In this case, the LPN is at an extreme drawback because she was the one staff member who counted drugs before leaving the power. This approach is inconsistent with best practices requiring counting by two people, with not less than one person holding a license, reminiscent of an LPN, RN, or APRN.

Requiring two people to perform the count reduces as much as possible the chance of incorrect counting and provides a legal witness to drug counting. The two drug counter employees have obligation for accurately counting drugs and have potential liability for any discrepancies. In the case of an LPN, she is the one licensed one that can certify that the calculations were accurate.

This situation raises questions, including:

• What did the power inspection involve?
• Did the LPN follow facility policy regarding the administration of narcotics, reminiscent of ensuring that the important thing to the drug cabinet was in possession only while on duty?
• Did she personally give the important thing to the day nurse who must have received it?

Another unanswered query is how the state public health department became involved within the case. Generally, a grievance could also be made by a patient or patients, a caregiver, nursing staff or a member of the patient’s family. The person making the grievance is confidential.

Because it has closed its investigation, it seems unlikely that the power would report the error unless it is permitted to achieve this under state law. Either way, the Ministry of Health got involved.

The LPN should retain a nurse practitioner or attorney as soon as possible, and positively before contacting the power or public health department.

There is little question that the LPN faces potential legal obstacles in this case because:

1. There isn’t any one to support her position that the calculations were correct on the time of departure.
2. There appears to be no other “suspect” to research.
3. If the Department of Public Health believes she passed the drug otherwise, she shall be reported to the state board of nursing for investigation and possible disciplinary motion.

Hopefully the LPN’s finding that the calculations were correct shall be confirmed by all parties. If that happens, this case could have a completely happy ending. Even if that is the end result, she must first undergo the following difficult stages that await her.

Although this particular case involves an LPN, all nurses should remember these lessons.

• Always follow your facility’s manual drug counting policy, each at the top of your shift and when you must sign for medications provided to you by an internal or external pharmacy.
• Always have a witness confirming the drug counter at the top of the shift or receipt of medication from the pharmacy – whether your facility’s policy requires it or not.
• Never lend the drug stash key to a different worker or leave it in an unsecured place.
• If a drug count discrepancy occurs while on duty, notify the unit manager and/or director of nursing and prepare an incident report as required by facility policy.
• If you’re notified that you just are under investigation for missing drugs, contact a nurse or attorney immediately.
• Document all medications administered during your shift in your patient medication administration records and nursing notes.
• Under the direction of your attorney, cooperate with any investigations.
• If you’re coping with a state board of nursing disciplinary proceedings, at all times ask for representation from a nurse or attorney.