Could I be accused of Fentanyl diversion?

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Could I be accused of Fentanyl diversion?

Hello there.

I read a post on a travel nurse facebook page about someone being accused of drug diversion from "missing narcs" and it got me thinking about some things...

I'm a travel ICU nurse in NY right now. I had a covid patient and pulled a fentanyl bag to put behind my currently infusing bag for when it's low and can change it quick to prevent any mishaps (although I do this with most patients if they're running through bags quickly and I know I'm having a busy shift and may not be there immediately when I need to be).

The facility doesn't have computers to scan inside the room. This is common practice to pull the next bag for when they're getting low, that way if it happens to go off and you're not there or if it's urgent you (or whoever hears your pump beeping) can quick get in there and spike your next bag whether it's a pressor in this case fentanyl. The MAR doesn't require a dual signature to start fentanyl. 

I'm just wondering, could I be potentially putting myself in a dangerous situation for being accused of diversion? If it is shift change and everyone is running around the last thing I would want is for a patient's sedation to run dry, arouse and self extubate haha. It seems we all put a lot of trust in each other whether we run to pull a med for someone or have a back up bag at the ready. I know some people will say the jcaho way is probably to not have the next bag at the ready when getting low... but let's be real I've been thankful many many times when I see a coworker's got their bag right there when they are in another room and the pump is going off.

For me, it's a prevent a tragedy thing, but I'm starting to see how it could potentially put me and other nurses in a position to have to defend ourselves. Thanks for reading.

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8 Answers

Specializes in Tele, ICU, Staff Development.

Dear Wondering,

This is not a good idea at all. Don't take a huge risk by leaving fentanyl (that you've signed out) in essence laying around for anyone to access.

  • You wouldn't leave a vial of morphine laying out on a patient overbed table.
  • You wouldn't hang a bag of fentanyl out "to use later" if you knew TJC was coming.
  • You don't want the sign out time in the Pyxis/Omnicell to be markedly different than the new bag hung time in the MAR......and documented by someone else.

I'm just thinking of all the many ways this could cause you great regret. There is such a focus on Fentanyl right now nationwide and even if there weren't, you don't want even the whisper of narcotic wrongdoing to threaten your license. 

The convenience you describe is not worth it. Find another way to avoid running low. Program your infusion pump volume accordingly. If your infusing bag is low, change it and document the small amount of waste with a colleague.

Also- if you're worried about your patient extubating themselves keep an eye on the propofol.

Best wishes,

Nurse Beth

I don't give a rat's behind about Jake-o, that's a game hospitals play and they are the main ones who need to worry about it.

What I care about is the other number of ways this could go wrong. There are a variety of ways nurses try to make up for serious problems and the greedy, unethical decisions by others (short staffing) but this is just recklessly putting yourself at risk--and for what?? It's risking a LOT just so that the staffing farce can continue and the right people keep making money.

It's bad enough that we do things like skip breaks because of short staffing; but trying to compensate in a way that involves not handling controlled substances appropriately is a whole other level of badness; it's risking a lot of things, including your ability to practice nursing at all.

No way. I would stop this immediately. If I felt there was no other way I would either change some of my nursing philosophies and FIND a way, or else not work in a place like that.

Specializes in Nephrology, Cardiology, ER, ICU.

Set a timer on your watch?

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I'm with JKL.  The whole thing screams "staffing issue".  I also agree that skipping breaks is bad enough; playing fast and loose with your license and livelihood are a whole other issue.

When you're up before the Board (or worse yet on the witness stand) do you think the brass is going to fall on their sword and admit their staffing practices made this necessary?  They will throw you under the bus in a hot minute.

Set the pump for a lot less than the bag capacity and don't be afraid to waste liberally to avoid running out.  Don't put your career on the line to save them a few more nickels and dimes.  You're doing enough of that already.

Pulling a bag of fentanyl, not starting it, or documenting it? Umm, this is not smart. You need to rethink yourself. This screams of a possible diversion.

At a former job; A nurse left a bag of Fentanyl in a patient's room. I think she  had to run out real quick, but when she came back, the bag was gone. Apparently, the patient's family had been visiting and it was suspected the family took it. How you prove that, I have no idea. I'm not exactly sure what all happened to the nurse, but I'm sure it wasn't good. 

I totally understand the staffing crisis. We are all feeling it.  Like a previous poster said; program the volume to be a lot less then the total volume of the bag or set a timer. ?

That is basically you leave controlled substance in patient room unattended, right? It can be taken by anybody.

You are trying to provide good, compassionate care. If you patient's sedation runs dry it's not going to be a great experience for anyone. But figure out another way. That bag of fentanyl has your name on it, and if it disappears it'll be you who has to explain and defend. I'm sorry, I know you're just doing your best in a tough system.

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