Need advice re: Reporting suspected drug diversion

[CloverPark, RN]

Hi everyone, I have never posted before, only commented, but I really needed some good advice, so here goes:

I am a supervisor in a LTC/subacute facility and I suspect that a nurse may possibly be diverting narcs. I know this would be a very strong accusation, so I have been thinking it over carefully for some time now.

First of all, let me explain WHY I am suspecting diversion:

1. I have had to count narcs with this nurse several times (when relief was going to be late and I was to take the keys until the oncoming nurse arrived) as well been present while this nurse was checking her narc count by herself near end of shift. MOST of the time, the count is short. That alone isn't what makes me worry, as I myself have frequently forgotten to sign narcs out in the narc book when I was a floor nurse. However, whenever the count was short, I would immediately remember giving it, and usually remember the time or have it recorded on my "brain sheet." I have also witnessed the same with other nurses. But the nurse I am talking about usually appears as though she does not remember ever giving it, struggles to explain why the count is short, and it appears obvious when she records giving it (after the count was short) that she is just making up a time. I do not feel though that this alone though would be enough to report her, so...

2. This nurse will often request pain meds (narcs) for a new admission before she even assesses them. A doctor has even witnessed and commented on this recently. She often will give me a list of meds she will need before the admission even comes in, and will add a pain med to that list if it is ordered. However, I do not get any meds for her until the patient has arrived to the facility and she is able to see/assess them. I choose to omit the reasoning as to why the supervisor has to get these meds for the nurse in order to not share any information that could possibly give away which facility I work at (we have unique policies/circumstances).

3. The first 2 items I mentioned are always involving the same narcotic: oxycodone (IR). If it was a variety of different narcotics (Ambien, Xanax, etc.) I would not have such a strong suspicion.

While I hate "drama" and would feel AWFUL if this nurse was innocent, I feel as though I need to do/say something because NOT doing anything (if she is guilty) is allowing for this to continue, and if one day she was caught and I was questioned, I would be guilty of not reporting my suspicions (I don't lie, so I would most likely admit to this).

What makes this more awkward is the fact that this nurse and I recently had an argument, so I do not want to be viewed as doing this to "get back at her" (I would NEVER make such a strong allegation out of spite!), and I do not feel comfortable (nor do I think it is wise) to approach her myself. Prior to this, we have never had any issues.

I would like to report this anonymously (if possible), but however, due to my position as supervisor, which makes me the only one capable of making the observations I have made, it would be easy to figure out it was me.

So what do you think I should do? Thanks in advance for your input...

[LOVEGREEN]

While some of the things you have noticed are suspicious, none are blatant enough to report as diversion. I would only report diversion if I witnessed someone take meds or if they appeared intoxicated. That being said, you could and probably should write incident reports each time the narc count is off.

[Lev, MSN, RN, NP]

First off, I would not discuss this case with anyone unless you are ready to accuse this nurse of diverting. You don't want to be caught in the middle of the situation where someone else reported her to the BON and it was was obvious that you were suspicious sooner. That being said, you should document each encounter with your suspicions to build a case once you have actual proof. People who divert can be manipulative and cause you to doubt yourself. If you have actual proof you should approach her with the evidence and tell her that she must enter some sort of program or you will report her to the BON. She may be diverting for a family member and may never appear impaired. The goal is to get her help not punish her. She should also be suspended from work until she is done the rehab program. It could be that if she checks herself into rehab she has to self report to the BON, however, this is better that her employer reporting her. I would tread very carefully.

[amypond1]

the fact that someone else has to get the narcs for her should raise question. she is probably already on probation or has already had an issue with diversion. Start documenting everything and take pictures when you can. the more evidence you have the better. This nurse sounds like real trouble.

[OrganizedChaos, LVN]

the fact that someone else has to get the narcs for her should raise question. she is probably already on probation or has already had an issue with diversion. Start documenting everything and take pictures when you can. the more evidence you have the better. This nurse sounds like real trouble.

Don't take photos. I don't see that being legal. But definitely keep a record of all instances.

[bugya90, ASN, BSN, LVN, RN]

Does your facility allow random drug testing? If so you as the supervisor should request a drug test. You can use the excuse of the narc count being off multiple times as reasoning or you could just draw names from a hat for 3-4 people and just be sure her name is one of them.

[Emergent, RN]

I went through this recently. I too started a thread. I ended up calling the head of pharmacy in the hospital. He told me that, yes, it all sounded suspicious. He said that he would start running checks.

2 months later the fellow suddenly resigned. I heard through a source that he was called into HR, a drug screen was demanded, he refused and resigned on the spot. I hear he was hired by Davita .

[GeneralistRN]

None of what you said is evidence of diversion. Not really at all actually.

Also I don't know where you live but in many states, the health department or diversion programs are unable to act on anonymous referrals or reports. Precisely because of people like you.

[KCMnurse, BSN, MSN, RN]

Go with your gut, you cannot report anonymously as a previous poster stated. Run it by your pharmacy or DON. You will never be 100% sure unless you witness her putting pills in her pocket or arriving impaired for duty. Seems to me you have enough to request a urine drug screen based on the count being off multiple times. If she is not diverting and just careless that should be enough to flush out the truth.

[Chinesedog]

Simply report, and follow your facility's protocol- unless a situation arises which could point to you being accused of the discrepancy. In that case, it may be in your best interest to seek employment elsewhere as a worst case scenario.

Davita?? That's funny you mention that, my former nursing instructor who had her license suspended when she was jailed for substance trafficking ended up getting a job at Davita. Maybe they are second-chance employers.

[aflahe00]

Davita is recovery friendly I think because no narcs are given

[aflahe00]

Drug diversion is a very serious accusation to make no matter your suspicions. Are you %100 sure? I would be careful if not. The consequences of such a crime can be severe.