Florida DOH Restricts License of Home Hospice Nurse Due to Morphine Impairment During Her Shift
After the patient of a home hospice nurse died, his family found the licensed practical nurse (LPN) who was supposed to be caring for him asleep due to being impaired by morphine. The Florida Department of Health (DOH) issued an emergency order (ERO) restricting the LPN’s license to practice nursing until she is evaluated and approved for work by the Intervention Project for Nurses (IPN)—an organization that monitors impaired nurses.
The outgoing nurse on the previous shift reported that she saw the LPN, who had just come on duty, take a vial of morphine intended for the patient and pour it into a drink which she immediately consumed. Then the LPN went into the bathroom with the empty vial. When the LPN came out of the bathroom, the vial was filled with a liquid—probably water.
According to the ERO, the impaired nurse’s supervisor was called and when she arrived found the nurse “asleep in the kitchen, standing up with her head resting on the stove. When awakened, the nurse slurred her words and didn’t recognize her supervisor.”
The supervisor reviewed the impaired nurse’s notes from the evening and found them illegible and incomplete. Also, the supervisor reported that whatever was in the morphine vial did not look or smell like morphine.
The ERO reports that the impaired nurse abruptly left the employ of the healthcare company before the incident was investigated. However, the DOH ordered that she be evaluated by an addiction physician who diagnosed her with mild opioid, sedative/hypnotic, and alcohol use disorders, and major depression disorder. The addiction physician also reported that the nurse’s concurrent use of morphine and lorazepam placed her and her patients at risk. He recommended “intensive outpatient treatment” along with a monitoring agreement with IPN.
Compliance Perspective
Failure to prevent misappropriation of controlled substances by staff members and failure by a staff member to report directly observing misappropriation of a controlled substance by another staff member and the accompanying risk of impairment and inability of that staff member to provide care for the patient may be considered abuse, neglect, misappropriation, and provision of substandard quality of care, in violation of state and federal regulations.
Discussion Points:
- Review policies and procedures regarding procedures for controlling, reconciling distribution, and storing controlled substances to prevent misappropriation.
- Train staff regarding policies and procedures for controlling, reconciling distribution, and storing of controlled substances and the responsibility of staff members to immediately report any observed or suspected misappropriation of controlled substances to their supervisor or through the Hotline.
- Periodically audit to determine if policies and procedures for controlling, reconciling distribution, and storing of controlled substances are in place and being followed.
