"Red Flags" of Drug Diversion - page 3

Listmates, My post is intended as a way of "helping" us in our work settings to possibly identify a peer or colleague who might be actively diverting drugs. None of us wants to "rush to judgement"... Read More

  1. by   leslie :-D
    Quote from TazziRN
    You're welcome, but for what?
    for clarifying;
    and newfound information.

    leslie
  2. by   TazziRN
    Anytime, my friend!
  3. by   icie rn
    Many nurses have sleeping problems, many rely on OTC meds or have a PCP who has written for a mild sleeping aid. Be advised that some of these meds can have an adverse effect when another health problem crops up. It happened to me when I was developing diabetes, taking a mild sleep aid, and came down with the mother of all sinus infections. I will not go into much detail, but thank goodness I could show I was working ill because I had been harrassed by the supervisor until I came in. She tried to deny I had told her I was not well, I was on meds, and I really had no business being there. I was supposed to only do paper work, but a good deed never goes unpunished, so when 2 patients expired that night, guess who was asked to do some meds, charting, and even tape. Well, I could not put my thoughts together in a coherent pattern for report and was accused of taking meds. This was after a count showed no narcotics missing and I had not been in the narc drawer all night. I got a lawyer, am still very adament regarding never working ill again no matter how bad the floor is, and the issue is mute. I just keep thinking my license was put a risk for no good reason and I was to blame because I gave in and came to work when I should have stayed home.
  4. by   Rnandsoccermom
    Quote from earle58
    i don't think i understand.
    if you're on a prescribed med and it alters your loc, you can be charged w/impairment.....even though it was prescribed???

    leslie
    Yes, we had a RN that admitted she was taking 900mg of Neurontin THREE times a day. She was sitting at the desk with the supervisor at 1 p.m. in the nurses station and was nodding off in the middle of the conversation. She could hardly hold her head up. She was sent home on the grounds of being impaired and not being able to function in the capacity was required for patient care.
  5. by   leslie :-D
    Quote from Rnandsoccermom
    Yes, we had a RN that admitted she was taking 900mg of Neurontin THREE times a day. She was sitting at the desk with the supervisor at 1 p.m. in the nurses station and was nodding off in the middle of the conversation. She could hardly hold her head up. She was sent home on the grounds of being impaired and not being able to function in the capacity was required for patient care.
    oops...i hit the thanks button accidentally.
    anyway, i agree that any nurse should be sent home if they're adversely affected by meds.
    i thought that tazz was saying the BON could charge one w/impairment, even when on prescribed meds.
    and that's what i was taking issue with....

    leslie
  6. by   oramar
    Quote from Cattitude
    There are a BUNCH of recovering nurses here that have done stupid things, this is true but WE ARE NOT IDIOTS.
    Maybe you should try learning about the disease of addiction first before name calling.
    Talk about timely. Time magazine's cover story is called "how we get addicted". Quote "even though as early as 1950 it was recognized by medical establishment that addictive behavior has all the ear marks of a disease, it continues to be viewed voluntary behavior". You might as well get used to the idea that it will always be viewed by a certain part of the population as immoral or stupid behavior. Perhaps because addicts do so many immoral and stupid things. Perhaps because so many people focus on results instead of causation.
  7. by   SuesquatchRN
    Quote from oramar
    You might as well get used to the idea that it will always be viewed by a certain part of the population as immoral or stupid behavior. Perhaps because addicts do so many immoral and stupid things. Perhaps because so many people focus on results instead of causation.
    Perhaps because we make it illegal for addicts to get their substances.

    The Drug War: Making Criminals out of Citizens
  8. by   leslie :-D
    Quote from Suesquatch
    Perhaps because we make it illegal for addicts to get their substances.

    The Drug War: Making Criminals out of Citizens

    sue, was there supposed to be a link?

    getting junkies clean syringes is one thing.
    providing them with a legal means of supporting their habits????
    i can't make any sense out of that.
    it wouldn't make the consequences of their actions, any less disastrous.
    what am i not understanding?

    leslie
  9. by   SuesquatchRN
    You understand.

    I have no problem at all with making it legal for people to take whatever the heck they want.

    I am an American over the age of majority. I am sick and tired of the health Nazis riding my butt. Now NYC restaurants can't even cook with the fats that work for them. Enough.

    The only things the drug war has done is make the US the western nation with the most non-violent offenders in prison, fund the Taliban and other anti-American groups, enrich organized crime, and make it nigh unto impossible for a person in chronic pain to get adequate medication for control.
  10. by   leslie :-D
    Quote from Suesquatch

    I have no problem at all with making it legal for people to take whatever the heck they want.
    i have major problems with it.
    many of us don't 'use' the freedoms we have in place, but rather abuse them to a point of self-destruction.
    i tire of the gluttony.
    the ubiquitous plea to salvage our constitutional rights, just goes too far sometimes.

    leslie
  11. by   Cattitude
    Quote from oramar
    talk about timely. time magazine's cover story is called "how we get addicted". quote "even though as early as 1950 it was recognized by medical establishment that addictive behavior has all the ear marks of a disease, it continues to be viewed voluntary behavior". you might as well get used to the idea that it will always be viewed by a certain part of the population as immoral or stupid behavior. perhaps because addicts do so many immoral and stupid things. perhaps because so many people focus on results instead of causation.
    oh i've been used to that for years already. my head is not in the sand. but if anyone continues to use offensive terms like "idiots" than i'm going to speak up.

    as far as time magazine, i haven't read the article, maybe i'll check it out. but i can say this of the above quote, anyone that views it as a voluntary behavior does have their head in the sand. who voluntarily signs up for this sickness? who volunteers to be so sick as to turn to desperate measures for their drug/drink, who?? no one i know. no addict wants to be an addict.
  12. by   SuesquatchRN
    Quote from earle58
    i have major problems with it.
    many of us don't 'use' the freedoms we have in place, but rather abuse them to a point of self-destruction.
    i tire of the gluttony.
    the ubiquitous plea to salvage our constitutional rights, just goes too far sometimes.

    leslie
    The point is that people will go to extraordinary - and criminal - lengths to obtain criminalized substances. I'd rather have an amphetamine addict take an Escatrol than something they synthesized from kitty litter and sinus medicine, and I'd rather that we don't lock anyone up for synthesizing said substance. Why? To punish them for liking to be high? How is that a crime?
  13. by   PLTSGT
    Wow! You listed more descriptions than one would found in any literature in this topic.

    Regardless if anyone find addiction as a disease or not, it is a major problem in our profession.

    Thanks for opening up a topic that is true but no one dares to discuss openly.


    Quote from WriteStuff
    Listmates,
    My post is intended as a way of "helping" us in our work settings to possibly identify a peer or colleague who might be actively diverting drugs. None of us wants to "rush to judgement" on such a critical issue as this. To accuse or even "suspect" wrongfully is a very hurtful place to go for everyone involved.

    However, the reality is that our working environment is inherent with accessibility, and availability of addictive drugs that can become a source of temptation for the Nurse who is battling her own demons of addiction.

    The "list" of red flags I am proposing is in no way all-inclusive. However, I submit such a "list" from my own experiences as the once impaired Nurse that I was, with the hope that if you see such similar red flags, they are "signals" that might not be ignored.

    As Managers, Charge Nurses, and Teammates we never want to "believe the worst" about our colleagues. Addiction is addiction, whether it's played out on the street corner, or within our medical settings, and within our medical settings we find it far more difficult to "believe" this could actually be happening, but it does.

    I also submit this information with the hope that, if you suspect a colleague has a problem with addiction, you might find the courage to take the necessary, and proper steps toward intercepting the diversion for him/her, because left unchecked , he/she is not only compromising the safety of patients, but contributing to the progression of the disease. By "intercepting" I simply mean reporting your observations, concerns to the person you believe will be able to help.

    This list is not necessarily in any particular "order" of importance, it reflects behaviors that potentially portray an underlying problem, when seen on a consistent basis:

    1. Volunteers, frequently, to work overtime, extra days.
    2. Uniform consists of a lab coat with pockets or clothing that is loose fitting.
    3. Often "disappears" from the unit aside from expected "break times" (meals, etc.)
    4. "Nods off" at the desk, or frequently c/o "feeling so tired" lately.
    5. Mood changes from quiet and subdued, to suddenly being animated, charming, engaging and confident.
    6. Avoids being in the Med Room when others are there, and is observed being alone much of the time (in the Med Room).
    7. When alone in the Med Room, and others enter, makes a hastey exit.
    8. Often "forgets" to sign out scheduled drugs until the end of the shift.
    9. Volunteers to be the one to "make out new narcotic sheets" for oncoming shift.
    10. Volunteers to be the one doing the Narcotic Sheet count, as opposed to the cupboard's Narcotic Stock supply at change of shift.
    11. Volunteers to give your "prns" for you.
    12. Volunteers to go to Nurse's Lounge and make the coffee whenever needed.
    13. Has a locker assigned, but rarely uses it.
    14. Often has "bruises" on top of hands, and covers them with a bandaid.
    15. Appearance of bloodstain (fresh) on uniform pants in thigh area.
    16. Her patients who are in pain "never seem to obtain effective relief", or are "still agitated, uncomfortable and anxious" when she claims she has "just medicated" them.
    17. Shops for orders for her patients relative to pain medication. i.e., "Dr. So-and-so....the Vicodin is not working for Mr/Ms "X", could we give something stronger" - when the Vicodin had been working all along.
    18. Charting reflects having "given" a narcotic injection to a patient on the day of discharge.
    19. Writes a T.O. order for narcotics, but never called a doctor.
    20. Volunteers to be assigned the sickest patient or patients. (who have narcotic orders in abundance)
    21. Frequently leaves out details required on Narcotic Sheets.
    22. Is often late to work.
    23. Calls in sick more than usual.
    24. Ignores, even "jokes" about the necessity of and seriousness of policy and procedure surrounding narcotic dispension and documentation.
    25. Pockets multi-dose vials of normal saline (10cc and 30cc).
    26. Has a "ready supply" of syringes and needles in her uniform pockets.
    27. Is known to never "empty" out pockets of such supplies at end of shift and before leaving the hospital.
    28. Gives conflicting information about her patient's degree of pain to oncoming shift. (on "her" shift, the patient was in "great" pain and "needed" medicating either more often, or with larger doses)
    29. "Forgets" to tell oncoming shift she "just" medicated patient with a narcotic, and conveniently "forgets" to chart same on med sheet.
    30. Is known to "save" partial doses of narcotics (not used), because...."patient might need it later."
    31. "Wastes" narcotics without a second witness, and asks you to "please sign" at end of shift - "I was in too much of a hurry and no one was around then."
    32. Distances self from management, administration, and others in charge.
    33. Rarely asks "for help" from peers with regard to patient cares requiring such help. (prefers to "work alone")


    This is an example of what might be observed in behaviors. There are many more I'm sure. I cannot stress enough that delicate place of not rushing to judgement, but at the same time relying on your common sense, caring concern and what your heart and gut might be telling you. If you find yourself in such a position, the better thing to do is take your concerns to even one person you trust, who will know how best to address your suspicions. You have the right and need to express your worries over such serious matters in the work place. An impaired Nurse on duty places her teammates in a very uncomfortable, and compromising position. When handled properly, the outcome for the Nurse, colleagues and patients, can be positive rather than tragic.

    Good Management knows the risks that are involved when an intervention is necessary, and should be prepared to deal with the risks. (one being suicide)

    I hope this is helpful information. Over a period of three years, I exhibited all of those behaviors, and toward the end, I was screaming (internally) to those around me......."don't you see what I'm doing, please, please stop me; someone help me!" And they finally did, before I could take my own life.

    Thanks for "listening."

    Bonnie Creighton,RN, MHCA
    Mental Health Consumer Advocate

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