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Use checkpoints to ID employee medication theft
Pharmacy alerts, logbooks are effective tools
There are two ways that the staff at Agape Hospice have identified cases of medication diversion by employees. One involved patients reporting less medication in the bottle than listed on the label. Another involved a nursing home hospice patient who was receiving pain medication on an as-needed basis but was running out of pills before the nurse's next visit.
The most incredible story an employee used to explain missing hydrocodone involved a clean car, says Debbie Williams, RN, CHPC, administrator at Agape Hospice in Minden, LA. "The nurse told us she needed another supply of hydrocodone because her husband cleaned out her car and threw out the medication she had left in the car for delivery to a patient the next day," she says.
The medication was reordered and delivered to the patient by another nurse, and Williams began monitoring the nurse that reported the medication thrown out by her husband. "We could not prove anything from the first incident but after seeing some trends that indicated a problem, we terminated her employment," she says.
Agape has several checkpoints in place to discourage employee theft of medication. "Our contract pharmacy notifies us if there is any unusual activity such as nurses who call in frequently to order more medication because the patient ran out," she says. "I will investigate the case to see if there is suspicious activity on the employee's part or if we need to have a physician re-evaluate the patient's medications."
Because the pharmacy delivers medications to the hospice office for the nurses to deliver to patients, the pharmacy employee signs the logbook identifying the medication and patient's name, says Williams. "The nurse signs the logbook verifying the amount of medication when she takes the medication to deliver to the patient, and the patient signs a sheet indicating that the proper amount of medication was delivered," she says.
This same procedure is followed when the medication is delivered directly to a nursing home in which hospice patients are located, says Williams. "Although I prefer that our nurses deliver the medication, some nursing homes require the pharmacy to deliver to them," she says. The logbook has improved medication record keeping and reduced the opportunity for nursing home employees to divert medication, Williams adds.