Question

A nurse had been working in a critical care unit for more than 25 years, gaining respect for her competence and dedication before suspicions began to gather that she was diverting narcotics for her own use. The acute hospital had recently installed a “computerized medicine cabinet” for enhanced distribution and better monitoring of narcotics. The cabinet recorded the nurse’s personal keypad code and the patient’s data before it could be unlocked and narcotics dispensed. The nurses were also required to document the narcotic usage by handwriting the patient’s name, medication, time, route, and dosage on a more traditional paper medication administration record (MAR). Discrepancies were noted between the nurse’s patients’ electronic data for narcotic administration and the handwritten notations made on the paper record. The nurse was first questioned by her supervisors and then she was suspended, as they did not find her explanations credible. Her grievance was upheld by the arbitrator assigned to the case and the hospital appealed. At trial, other nurses from the same unit testified that they frequently completed their paper record documentation during their breaks or at the end of the shift, often when they could not remember exactly what medications or dosages they had administered to patients. There was additional information that the nurses would electronically sign for narcotics, prepare IV drip bags in advance of when they were needed, and then discard these IV bags when they were no longer required or the physicians had changed the medication orders. Additionally, these nurses testified that they often deviated from the physician’s order for an IM injection, electing to give the medication by an IV route. Finally, there was testimony that the hospital had no formal policy for which nurse was to document narcotics in the paper record when two nurses, such as a preceptor and a mentee, both had responsibility for the patient. The nurse who was suspended testified that she, too, frequently entered data into the paper record long after she had administered the medication and, in some rare instances, entered the data on the following day.

Did the facility have sufficient evidence to suspend the nurse?

How should the testimony of the other nurses in the unit affect the outcome of this case?

What additional questions should the institution address before the court rules in this case?

How would you have ruled in this case?

Answer 1

The facility had sufficient evidence to suspend the nurse on the grounds of suspicion. (Nurse keypad and patient data mismatch, inadequate credible information, lack of documentation)

The testimony of other nurses can affect the case by making the hospital environment poor management in regards to narcotic drug management, work load ,stress of the nurse could be the cause for these types of accidents.

Some of the additional questions which has to be addressed are

• Was there any misuse or misbehaviour among the staff
• Is the problems are in other departments as well
• Was there a damage to life

This case could have been ruled by having a thorough assessment on the system (from pharmacy to the patient cabin) through a nurse. Thus could have provided a clear information on when it was issued and when ,how ,how many ti MH es it was administered to the patient.Maintaining an electronic records in addition could have prevented these types of incidents.