Is your narcotics practice `significantly different?'.

Author:Tammelleo, A. David

IS YOUR NARCOTICS' PRACTICE SIGNIFICANTLY DIFFERENT? If it is, you may be earmarked for scrutiny by your employer as well as your peers. Although the level of use of narcotics dispensed will often significantly differ from nurse to nurse, there are certain parameters. If your record for dispensing narcotics often exceeds that of your peers by a significant amounts, you may be subject to scrutiny. However, nurses should never deliberately withhold needed medication from patients for whom narcotics are prescribed. Nurses should never attempt to withhold narcotics from those who are in need of prescribed medication for pain relief. Nor should nurses attempt to substitute their personal tolerance of pain for that of their patients. In some cases, the amount of narcotics dispensed in excess of what might be reasonably expected in the most exigent of circumstances may lead to some unwanted attention. That was the situation with which one nurse was confronted in this unusual Vermont case.

SHARON DULUDE WAS EMPLOYED AS A NURSE WITH FLETCHER ALLEN HEALTH CARE, INC. (FAHC) FROM JULY 1, 1991, TO APRIL 20, 1995. Nurse Dulude did not sign a contract of employment. The duration of her employment was open-ended. In the fall of 1992, FAHC terminated Nurse Dulude for allegedly diverting narcotics, falsifying her patient's medical records, and failing to meet the standard of practice regarding the administration of medication. A medication and narcotic audit was performed by a committee comprised of the Head of Pharmacy at FAHC, the Vice President of Nursing, the Nurse Manager, and the Head of Human Resources. Based on their audit, the committee felt that there was enough evidence to substantiate the fact that Nurse Dulude's narcotic practice was significantly different from that of her coworkers. Nurse Dulude appealed her termination. FAHC reinstated her on November 23, 1992. Her letter of reinstatement noted that her pattern of medicating patients was "distinctly different" from other professional nurses on her unit and that she, as an individual, repeatedly signed out and documented the use of as many Percocet in twenty-four hours as all unit nurses combined. The letter acknowledged that Nurse Dulude and FAHC had discussed Nurse Dulude's philosophy of pain medication and that her return to work would be premised on specific conditions requiring her to receive supervision and education in the administration of narcotics. After a patient complained that...

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