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Comprehensive article on how to detect and deal with diversion

Has 27 years experience.

I'm ever fascinated by the secret world of diversion by nurses. I thought this article excellent. The whole subject is somehow intriguing to me. This article is comprehensive!

Detecting and Responding to Drug Diversion | Pharmaceutical Diversion Education Inc.

By Kimberly New, JD, BSN, RN

Detecting drug diversion within an institution is a challenging task that requires creativity and collaboration between multiple departments, particularly pharmacy and nursing. Diverters are invested in concealing their activity. Aware that the institution is attempting to discover and thwart their actions, their focus is on outwitting surveillance in order to feed their increasing need for the diverted drugs. Detection should rely on the use of analytics and should include recognition of patterns in the transaction history beyond what is included in statistical outlier reports. Ultimately, when confronting a suspected diverter, the investigator should possess information the diverter is confident will go undiscovered, and the response to diversion should be swift, consistent, and ever-focused on the safety of patients, the diverter, and the community at large.

Edited by traumaRUs

The author of this article gave a presentation to the National Council of State Boards of Nursing which you would probably find interesting. The audio and slides are available here

Healthcare Facility Diversion Investigations | NCSBN

She presents some cases she investigated and shows some of the reports they used to detect diversion.

I take very little at face value.

What I suspect with regard to this topic, is that the problem/issue of nurses diverting drugs is one that presents itself like a beautifull-wrapped package with a fantastic bow, or like the frosting on the perfect cake. This is way better than any of the previous "small potatoes" ways to scare, threaten, and control nurses, and the timing is ripe for it with the problem of prescription opoid abuse in the forefront.

Why would I possibly say this?

Because underlying supports for nursing are, well, shall we say not in order. Staffing in particular. When you look over lists of [supposedly] suspicious behaviors, you will find a number of things that can and DO go hand-in-hand with the common practice of spreading nurses as thin as they can be spread. The nursing house is not in order, and it's not because of diversion. But there IS a great need to have absolute control over such a large segment of health care providers.

Everything about the hype over this has the potential to wreak havoc upon innocent parties. This is an issue that is easily exaggerated by the fact that every nurse has "heard a story about..."

When we see these lists of "suspicious behaviors" we should all be asking ourselves whether there is any legitimate scenario in which the behavior could take place. I actually haven't seen a list yet in which the majority of the items weren't behaviors that could just as well be perfectly legitimate as suspicious - and the chances of them legitimately occuring in less-than-ideal staffing situations and other situations where there is "controlled chaos" (such as an ED) increase their likelihood exponentially (in my mind anyway).

We are all absolutely screwed if this becomes a witch hunt with specious lists of behaviors that will be twisted into suspicion of a FELONY. We are holding the cards, for sure - but we aren't dealing them. Remember that.

And to the first person who says that innocent people shouldn't have anything to worry about: "Famous last words..."


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