My mom receives pain meds (Norco) for her pain from MS. Yesterday at 4pm she asked for her pain meds at her nursing home and the nurse said that they were out and waiting on the pharmacy to deliver. Next day, still no meds, she was in pain all night and constantly asking for them. Next day I call and the meds are supposed to be there by 3pm. Still not there at 8pm. I call and threaten to call the state in the morning if her meds are still not there. At that point they decide to go get them from a special locked place they have at the nursing home. Why didn't they do that right from the beginning? This is the second time this year they ran out of her meds. How can this happen? They blame the pharmacy but I'm not so sure. Is this common or is this something that should be reported?
My guess is that the folks left in charge are caught between a rock and a hard place. They don't want to elevate the problem for whatever reason until you make it more comfortable for them to do so than not.
I got a lot of lip on why it didn't happen properly but bottom line until I complained nothing happened. I hesitate to complain for fear I might make the situation worse but when your loved one is in pain and you are the one trying to help them it makes it very hard to do nothing.
Next time if, God forbid, this happens have the staff call the NH/rehab doctor, let him know the situation, and ask him/her to write for another pain med- even if it's a different strength. The nursing staff can either give the patient a stronger pill cut in half (the pill must be scored and not a time released formula so it can be cut in half properly) or the pharmacy can cut the pills in half for the NH to administer. The NH should inform the pharmacy that they will only need enough pills to last 2-3 days or long enough for the pharmacy to restock and provide the correct dose to the NH for your mom, but enough to get her through a few days.
1. Your mother was left in pain. She shouldn't have been. If that was the fault of the system the NH is using, they need to tighten up the system.
2. Suddenly discovering that they did have some after all in their magic cupboard makes me narrow my eyes. You only have the nurse's word for it that the pharmacy supply hadn't been delivered. It's not impossible that only that day's meds mysteriously "went astray" and for "some reason" the staff didn't want to ask for replacements.
But don't make any accusations: report what happened and ask how it will be prevented from happening again.
I'm so sorry to hear what happened with your mom's pain meds. I would report it as well. That does not seem in line with proper patient care. Its like you said if they had an emergency stash, why wouldn't they use it right away? Your mom needed that medication. I wouldn't let this slide and report it.
It was terrible that your mom was in pain for that long.
I would ask the administrator to complete an incident report ( an internal document) and ask the admin to bring it to the Center's Quality Assurance Committee for their review.
Then ask then what steps they are going to take so that this type of episode doesn't happen again for anyone in their care.
Like Shane mentioned above, have administration sort out what happened. The pharmacy manufacturer could have stop production of said pills, which is common.... thus the nursing home pharmacy supplier wasn't able to obtain said pill, some even try to contract other branches of that pharmacy to see if they had said pill in stock.
As for the locked vault for controlled substance, usually it takes a certified med tech that can open that vault, and at the time maybe none was on duty.
This situation could have happened even if the elder was living at home. My Dad use to wait until the pill bottle was empty collecting dust before he would mentioned he ran out of pill. I couldn't use the local pharmacy, Dad only wanted to use the mail order pharmacy, which is another week delay.... [sigh]. Tried to get Dad to go on automatic delivery but he refused.
Raise it first with the NH staff and if your get no satisfaction go to the state.
Pharmacies do frequently run out of medication which is a good reason to order a few days early for everyone.
Pharmacies tend to run their inventories very low to save money so this can happen a lot. It has happened to us several times with very common drugs not narcotics.
Often the NH staff will "borrow" from another patient till the new supply arrives. i don't know if this is legal or not but it does go on.
As for the emergency stock, every nurse in the place who has access to medications should know about the emergency stock. The nurses on duty when your Mom was admitted should have been questioned.
Note to all caregivers. Make sure you always have a list of your loved ones current medications with you at all times. When admitted to any facility ask the nurses to confirm all medications are available and have been provided. Question any aditions or deletions and understand the reason for the change.
Hospitals generally have their own pharmacy so being out of stock is an not usually an issue, but the time it takes the Dr to write the order, the pharmacy to approve it and send it to the floor can take several hours. You need to do these things on admission because you have be advised not to visit for a couple of weeks when admitting a dementia patient to a NH.
This happened at my dad AL. h His diabetic medicine ran out and a couple of times they couldn't get him lancets!! Long story...they always passed the blame to someone else.
Thanks to Aging Care I know what to do next time. Dad not there anymore but mom is so now I have knowledge on how to handle it.
Yay for you and your mom!!
A few key points need to be made. First of all by what you've explained, your mothers meds (no matter the class of actual med be-them opioids or not) have been on-going and have refill history that is not sudden, nor new. Meaning any issues would have been long worked out, so if that is a reason the facility is using, they are lying, even if the pain meds needed another written hard copy to fill the order. These facilities are not new to the processes and stipulations of medications. Medication is one of the few regulatory areas that is "regulated and fined when medication dispursment is misappropriated within facilities.
Secondly; do not listen to anyone if they suggest you do not report it to your state regulatory entities. I read you stated the facility ombudsman will report and investigate (an ombudsman in its capacity is paid and employed by facility regardless what they tell you about being advocate for your mother.
(Always look for advocacy (loyalty) within a paycheck) ...You do not ever not rely on those or anyone else to report this or any neglect, abuse or malpractice. I repeat, you do not rely on others to report.
You"" You yourself must Report the event to your state authorities as soon as humanly possible regardless any other person telling you "they will report and/ or even investigate. You will need to make sure that "you yourself report this incident to the exec management of facility and state entities.
Doesn't matter the order in which you report, state then facility, but! It does matter that when you report to both state and facility, etc, I strongly request you do so "in writing" (email is considered writing) to all entities, and you make a copy of each report and you retain those copies in a safe place for an indefinite amount of time.
If you do not do so in writing and if you then do not retain-copies, the chances the incident being reported to proper entities in a regulatory fashion are slim to none by the facility, and the chances of the report being lost within any state system (or eve being set aside) are high.
Now, I want you to stop and think of the facility telling you "we have an emergency stash" ... stop and think about that. Where and how has an emergency stash been created. An emergency stash is created by A. A resident left and left meds behind by either leaving the facility, died, or discontinued med /meds. B. A resident for what ever reason had not been able to ingest their prescribed meds for a period of time. C. A prescription was sent with too many in number and did not match the prescribed amount per month. ...... ---- Now that I've explained the possible reason/s an emergency stash could be created, I now need to tell you that within a facility all medications not used, not ingested, not prescribed, in any and all cases all "All" medications are to be disposed of, or returned to pharmacy, and that process is to be documented and is intended to be regulated. In laymen's terms, an emergency stash is never allowed to be in a facilities posesssion, legally. The act of Medication misappropriation (ingestion mistakes, withholding medication (intent to harm) or theft, are all illegal activities deemed punishable by fine or liscensure risk and penalty.
Facilities need "watch dogs" the states do not do the job. The families and friends of these individuals that are left in these facilities must, I say must be the "watch dogs" and whe a problem is alerted and found by the family and friends of the or other individuals it becomes your responsibility to become serious about what ever neglect and abuse and medical malpractice is seen and heard of.
Last mention by me; If it is a pain medication that she has been taking for any length of time, Your mother could have very likely gone into a physical and mental withdrawal, which then could lead to physical stress and mental stress causing medical emergencies and possibly death by the chai reaction of withdrawal and what it does to a body i.e.; heart central nervous system and brain functions.
#2. The wording "you do not ever 'not rely on others" Should read "you do not ever rely on others to report"
Norco is a VERY inexpensive and widely used narcotic. I can't imagine a NH "running out" and actually, they had only "run out" of your mom's.
Pill pilfering is rampant in NH's. It's a real problem. When my mom had one of her many surgeries and was taking Norco daily, she'd go as long as she could between doses, and then they'd string her along until she'd be gritting her teeth in pain. THEN the pain was out of control and instead of one dose helping, she'd be miserable until the dosage in her body was sufficient. Going 24 hrs in terrible pain takes a toll that one pill isn't going to cover. It could take a couple of days to "catch up".
I'd for sure raise a stink. This has all the earmarks of someone in the NH stealing patients meds.
The "opioid epidemic" is more a problem of people selling them on the street than people in chronic pain having access to what they need to get by on a daily basis. Sadly, however, they've made sweeping laws that essentially throw the baby out with the bathwater. Drs. are afraid to treat people who have chronic pain, people WITH chronic pain are treated as junkies.
I believe we are talking about Schedule 3 Controlled substances i.e. norco, oxycodone, dilaudid, OxyContin, Morphine & fentanyl, not sure but maybe tramadol (why I don't know). Are your meds in that class?
No snark either, please. That was uncalled for. As far as what else you wrote I didn't particularly agree with it, but it's your opinion and I respect it.
To quote "Tired" -
"You are only correct in needing a hard copy refill on opioids "If and only if" physician has not placed numbered count of refills allowed upon original prescription" -
Tired, this statement is blatantly incorrect for the narcotics listed above. Doctors don't give refills on those anymore.