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Safe Controlled Substance Handling

Don't be Accused of Drug Diversion: How to Safely Handle Controlled Substances

Drug diversion is the act of intentionally, illegally taking controlled substances.

As a result of the increased number of healthcare providers who divert and abuse controlled substances, employers have had to put practices into place to alert them to possible diversion. Nurses who divert drugs pose a significant risk to patients.

 

But I didn't divert! Imagine being accused of diverting drugs when you didn't!

I have represented several nurses who were accused of diverting, terminated and then called before the Minnesota Board of Nursing.

It has been documented that about 15% of healthcare providers have drug dependence at some point during their careers. This creates a risk of harm to patients because the caregiver may be impaired or may be stealing the patient's drugs, sometimes replacing it with saline, or stealing the drug waste.

Warning signs of diversion include:

  • Patients receiving maximum pain dose without relief (a pattern)
  • Always needing to waste some of the drug
  • The nurse visits the facility during non-work time
  • Deterioration in physical appearance, work habits and productivity
  • Asking the witness to sign after the drug has already been wasted
  • Increased absenteeism, tardiness, frequent unexplained absences from the unit
  • Reduced productivity
  • Frequently volunteers to count narcotics or medicate co-worker's patients
  • Tendency to administer more narcotics than other nurses on other shifts
  • Increased wasting related to breakage, contamination or patient refusal
  • Frequently asking for additional pain medication orders for patients
  • Dose signed off in narcotic supply but not documented on medication record as given
  • Forgetting to obtain a witness, or too busy
  • Removes larger dose than necessary
  • Controlled substance withdrawal times do not correspond to administration times
  • Inaccuracies in narcotic counts when certain nurse is working
  • Controlled substances signed out for patient who does not have an order for them
  • Coming to work early or staying late
  • Going to the bathroom directly after withdrawing medications
  • Extra long breaks

Safe practices include:

  • Waste immediately with a witness if the dose is known or if you are not titrating (waste to ordered dose prior to administration)
  • Administer drug in close proximity to removing it from medication dispensing system or waste it Account for every drop of IV medication or pills
  • Know and follow your facility's controlled substance policies
  • Actually witness the waste, no 'honor' system
  • If you pull you push, nurse who is to administer the medication, withdraws it (except during emergency)
  • Withdraw smallest amount possible
  • Chart administration as soon as possible
  • Chart pre and post administration pain scales
  • Ensure that your orders reflect your practice ie: morphine for pain of 8 or greater, but you and your colleagues consistently medicate for pain of a 6 or greater (this is practicing medicine!)

Missed documentation, or sloppy charting will get you in trouble!

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The Minnesota Board of Nursing

Receiving a letter from the Minnesota Board of Nursing is every nurse's worst nightmare. Often nurses who are reported to the Board of Nursing have been terminated from their nursing job or 'resigned in lieu of termination.' (Both are reportable by law). As if losing your job isn't bad enough, now you have to defend your nursing license, your livelihood, who you are!

While being represented by a lawyer is not mandatory, it is highly recommended. You have worked hard to become licensed as a nurse. I know. I am a nurse. Having legal representation will provide a nurse with the best possibility for a fair outcome. The Nursing Board is represented by an attorney from the Minnesota Attorney General's Office, shouldn't you be?

 

TheĀ Minnesota Board of Nursing's mission statement reads:

"The mission of the Minnesota Board of Nursing is to protect the public's health and safety through regulation of nursing education, licensure and practice."

This may be a surprise to many nurses. The reality is the Nursing Board is charged with protecting the public from nurses who are not safe to provide patient care, not protecting the nurse.

Nurses are held in high public regard and we, as nurses, must do all we can to uphold that public trust. Nurses must help each other when deficiencies in practice are noted or when changes are noticed in a nurse's practice and physical appearance as that may indicate a substance abuse issue. We should confidentially encourage the nurse to seek help before the consequences become severe.

Nurses are human. We make mistakes, and we too can suffer from substance use disorders (addiction) just like anyone else. We can become overly sensitive to our patients' needs and end up crossing boundaries, or have a boss who just 'has it out for us.'

After over 30 years as an RN, I can say I have not ever met a nurse who didn't put his/her patients first, providing the best care possible even under adverse conditions.

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Submit your request for a FREE evaluation by phone.