An Iowa nursing home is facing $1,000 in fines after a registered nurse (RN) was caught allegedly stealing and consuming residents’ painkillers while on duty. The facility was cited for a recordkeeping violation and resident abuse due to its failure to investigate and report the theft of medications.
According to state inspection reports, video surveillance footage from the nursing home shows the nurse taking two boxes from the medication cart shortly after midnight on Sept. 19, 2024, and placing them in a bag. Later that evening, around 7:30 p.m., the nurse was seen carrying a pink cup into the medication room, removing two boxes from her pocket, and mixing the contents with water. The video then shows her drinking from the cup at the nurses’ station a few minutes later.
At 10 p.m., the nurse was seen again in the medication room, allegedly dispensing liquid from a small bottle into a cup before drinking from it. The video also reportedly shows her visibly disoriented, appearing to stagger and lean against a door while another nurse cleaned the room.
A certified nurse’s aide (CNA) later told inspectors that she had helped the nurse to a place to lie down. The aide described the nurse as having glassy eyes, slurred speech, and difficulty walking, likening her to someone about to fall over. The nurse reportedly slept in a conference room until 2 a.m. before leaving the building and falling asleep or passing out in her car.
A licensed practical nurse (LPN) who worked that night told inspectors she had seen the RN in the medication room with a spilled bottle of Ativan or morphine, stating that the nurse appeared disoriented and was popping pills everywhere.
The following morning, the restorative nurse found the RN slumped over, either asleep or passed out, in the front seat of her car. A week earlier, a staff member had reported to the director of nursing (DON) that the facility’s narcotics inventory was “significantly lower” than the RN had reported, and that the nurse appeared disoriented while on duty. However, the DON, who acknowledged receiving a report about missing morphine, admitted she had forgotten to investigate.
The nursing home’s pharmacy later confirmed that both morphine and oxycodone were missing, with no explanation for the disappearance. The three residents whose medications were stolen were all diagnosed with dementia, and one had lung cancer.
Compliance Perspective
Issue
Substance use disorders affect approximately 10–15 percent of the general population in the United States, and nurses are not exempt from this statistic. Given their access to medications in healthcare settings, it is estimated that around one in ten nurses may struggle with substance use disorders. This underscores the need for healthcare facilities to implement proactive diversion-prevention programs to mitigate risks and ensure patient safety. Failing to establish such programs can lead to serious consequences, including diminished quality of patient/resident care, significant legal and ethical issues, and potentially severe citations when diversion problems are discovered. Nurses who divert medications often use sophisticated methods to conceal their actions, making early detection challenging. To effectively combat drug diversion, healthcare facilities must focus on identifying high-risk medications, recognizing signs of diversion, and monitoring indicators of nurse impairment. By addressing these areas proactively, facilities can better safeguard against the negative impacts of drug diversion and maintain high standards of care.
Discussion Points
- Regularly review and update your policies and procedures on preventing, identifying, and responding to drug diversion. Ensure they reflect current best practices and regulatory requirements.
- Provide comprehensive training for appropriate staff on preventing, identifying, and responding to drug diversion. Education should include the impact of drug diversion on residents, highlighting it as a form of abuse and neglect; staff responsibilities for reporting suspicions immediately; and the legal and ethical consequences of diverting controlled substances. Med-Net Academy offers three PowerPoint training programs in our Substance Use category; visit MNA to access these resources.
- Conduct periodic audits to ensure that all controlled substances are accounted for at each shift change and that proper documentation is maintained. Involve your consultant pharmacist in the auditing process to ensure thorough oversight.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*