Don’t be Accused of Drug Diversion: How to Safely Handle Controlled Substances
Drug diversion is the act of intentionally, or illegally taking controlled substances. As a nurse, being accused of drug diversion can be scary.
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 a nurse accused of drug diversion 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 them 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 drugs
- 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
- The dose was signed off in narcotic supply but not documented on the medication record as given
- Forgetting to obtain a witness, or being too busy
- Removes larger dose than necessary
- Controlled substance withdrawal times do not correspond to administration times
- Inaccuracies in narcotic counts when a 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 the drug in close proximity to removing it from the 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, the nurse who is to administer the medication withdraws it (except during an emergency)
- Withdraw the 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 the pain of 8 or greater, but you and your colleagues consistently medicate for the pain of a 6 or greater (this is practicing medicine!)
Missed documentation or sloppy charting will get you in trouble!