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!