Forged scripts dispensed at nurse’s own hospital pharmacy

A nurse’s attempt to misappropriate oxycodone was foiled by a patient who wanted to see her medication before discharge

A nurse has been found guilty of professional misconduct and found to have an impairment, after she forged scripts for oxycodone and attempted to take oxycodone intended for a patient.

The nurse worked at a Western Australian hospital when in November 2018, she attempted to misappropriate four oxycodone 5mg tablets and 10 paracetamol 500mg tablets intended for a patient who was being discharged that evening, to take home.

The nurse and a colleague, identified in a WA State Administrative Tribunal transcript as Nurse A, went to the drug room at the hospital’s ED that day together.

“The Respondent removed a blister packet of ibuprofen tablets from a cabinet in the Drug Room, pushed four ibuprofen tablets out of the blister packet into her right hand then returned the blister packet to the cabinet,” the transcript states.

“With the four ibuprofen tablets in her right hand, the Respondent walked to the schedule 8 drug cupboard, unlocked it with a key, opened the cupboard and picked up a blister packet of oxycodone 5mg tablets.”

She asked Nurse A to go and get an envelope for the patient’s take-home medication, which the other nurse did.

“Whilst alone in the Drug Room and with the Schedule 8 drug cupboard open, the Respondent pushed four oxycodone 5mg tablets out of the blister packet into her left hand,” the Tribunal noted.

“When Nurse A re-entered the Drug Room with an envelope, the Respondent dropped a strip of ten paracetamol 500mg tablets and the four ibuprofen tablets from her right hand into the envelope.  The Respondent said to Nurse A that the envelope should be sealed.

“Nurse A and the Respondent left the Drug Room to deliver the envelope of medication to the patient, at which time the Respondent had the four oxycodone 5mg tablets concealed in her hand or alternatively in her pocket.”

But the patient asked to see the take-home medication before the envelope was sealed, and when Nurse A opened it, she saw that it contained ibuprofen, not oxycodone.

The two nurses went back to the Drug Room, where Nurse A asked about the medication and her colleague took the oxycodone out of her pocket and put it in the envelope, saying she “must have mixed up the tablets”.

The next year, in April, the nurse forged a script for 20 oxycodone 10mg tablets in the name of Ms B, an outpatient.

She had obtained a blank script from the hospital, and used the name and prescriber number of a doctor who worked there to forge the script, including Ms B’s personal details.

She wrote on this Prescription, “Oxycodone 10mg TDS / PRN 20 capsules”.

She presented it to a pharmacy within the hospital, signing it purportedly as Ms B’s agent, paying for and taking the capsules.

The next month, in May 2019, she forged two scripts for a total of 40 oxycodone 10mg capsules in the names of two former patients of the hospital.

To do this, she altered two blank scripts by crossing out the prescribing information of the original doctor and writing in the name of another who worked at the hospital, using this doctor’s prescriber number.

On one, she wrote the personal details of a former patient, and on the other, she placed a sticker containing the personal details of a different former patient.

Again, she wrote, “Oxycodone 10mg TDS / PRN 20 capsules” and signed and dated the scripts as the prescribing doctor.

Later that day, she had the scripts dispensed at the hospital’s pharmacy, taking the oxycodone for her personal use.

Five days later, AHPRA received a notification about the conduct.

In June 2019, the Nursing and Midwifery Board’s Immediate Action Committee imposed a condition on her registration, that she not practise as a nurse until she had been deemed fit to do so.

The Tribunal heard that the nurse had an impairment – a substance use disorder (opioid) and an adjustment disorder – which detrimentally affected, or was likely to detrimentally affect, her capacity to safely practise her profession.

She told the Tribunal that these health impairments had been developed in response to “a series of traumatic events” in her life and had been addressed as part of treatment.

She said her substance use disorder was in remission with the assistance of buprenorphine/naloxone mixture and psychological therapy, while her adjustment disorder was currently in remission with the assistance of psychological therapy.

The Tribunal made the decision to reprimand the nurse and cancel her registration. She will not be able to reapply to be registered again for 12 months.

She was also ordered to pay costs of $2,000.

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