Missing opioids, such as fentanyl, led to a Fort Lauderdale registered nurse being adjudged unsafe to practice nursing.
Before Michelle Bungo got hit with an emergency restriction order (ERO) by the Florida Department of Health Aug. 5, the ERO says, she was fired by Holy Cross Hospital for violating its controlled substances handling policy.
Holy Cross had installed a Pyxis machine, an automated drug-dispensing machine that logs which employees get medications for which patients. It also allows for easier auditing of employees, which the ERO says Holy Cross did of Bungo earlier this year.
“The audit revealed that from Jan. 10, 2019, to March 6, 2019, Ms. Bungo made 14 withdrawals of controlled substances but did not document the withdrawals,” the ERO said. “Among the controlled substances that Ms. Bungo withdrew but did not document were hydromorphone, fentanyl, morphine, and lorazepam.”
That’s lorazepam, an anti-anxiety drug sold under the brand name Ativan, and three opioids used for pain medication. All three are Schedule II medications, which the Department of Justice and DEA define as having “a high potential for abuse which may lead to severe psychological or physical dependence.”
The ERO said: “The audit also revealed that Ms. Bungo’s controlled substance withdrawal rate was significantly higher than her peers.”
Also, four times on March 14, Bungo took out hydromorphone, but didn’t document the leftover hydromorphone until later. Bungo told a manager that sometimes, difficulty in finding a witness to the waste of the drugs meant waiting until later.
“Ms. Bungo also stated that it was normal practice for nurses to sign-off as witnesses for controlled substance waste even though they had not actually witnessed the administering nurse waste the controlled substance,” the ERO said.
And two nurses who were down as witnesses to Bungo’s March 14 hydromorphone waste told a manager they hadn’t actually seen it.
As for the 14 undocumented withdrawals, “Ms. Bungo stated that she was either busy or just didn’t hit the ‘save’ button.”
That wasn’t good enough for Holy Cross, which fired Bungo. She contacted the Intervention Project for Nurses (IPN) and saw addiction specialist Dr. Theodore Treese for evaluation.
“During the evaluation, Ms. Bungo revealed to Dr. Treese that she had recently used morphine, cannabis, fentanyl, and drank alcohol in excess while in Miami for a wedding,” the ERO said.
A PEth test, a blood test for alcohol consumption, that comes back at 20 nanograms per milliliter is indicative “of prolonged alcohol consumption or binge drinking,” according to the Department of Health. The ERO said Bungo tested 267.1 ng/ml.
“Dr. Treese diagnosed Ms. Bungo with severe, uncomplicated alcohol disorder; severe, uncomplicated opiate use disorder; mild, uncomplicated cannabis use disorder; and unspecified anxiety disorder,” the ERO said.
“Dr. Treese opined that Ms. Bungo is not able to practice nursing with reasonable skill and safety to patients.”
Her license is restricted until IPN tells the Department of Health that she’s safe for nursing.