drug diversion

mc3, ASN, RN · Jun 1, 2008

I did have one situation where the patient's comfort kit didn't have any Roxanol. When I asked where it went, I was told "I don't know":banghead: by both patient and family. My supervisor said this had happened there before (I was new at that time), and that from now on, the strongest med we could keep in the house was Darvocet....Another time, a patient's husband was helping himself to her Percocet. Believe it or not, that supervisor's attitude was "well, it belongs to them - what can we do?) :banghead:

I think trying to be "tactful" won't work. I would level with patient and family and tell them we won't be able to keep anything here if you continue to abuse it. Period. (Sorry if that sounds harsh - I have no patience with family taking meds from dying patients...)

mc3

doodlemom · Jun 2, 2008

I've experienced this with many different patients. Depending on the situation, we have done different things such as only dispensing 2 days worth of medication at a time or asking that the family provide a lock box so that the abuser cannot get to the med (if there is a responsible adult.)

shrinky · Jun 3, 2008

We have encountered this in several homes and we also limited the amount we dispensed or had the family provide a locked box in the home. In one home the patient was confused and took more meds than she was supposed to take, so we placed the meds out of her reach. I would hate for my patient not to have the meds he/she needs because of diversion, so we would always try to limit the quantity taken in at a time.

silaaty · May 5, 2011

Has anyone encountered an incidence in which you suspect the family is using the patients narcotics for themselves?
How to you approach this subject tactfully?

Does any one have a contract to have suspected diverter sign with your agency?

SilentfadesRPA · May 6, 2011

Does any one have a contract to have suspected diverter sign with your agency?

The operative word here is suspected - I would be very cautious from a legal stand point that later this did not come back to bite you.

Marc

tommytwice · May 8, 2011

-------Does any one have a contract to have suspected diverter sign with your agency? --------

Yes, sometimes we'll make them sign a contract if more meds are being used than what the order is written for. The problem is that the contracts are pretty much useless unless your hospice is willing to discharge the patient if the contract is broken. And when people have an addiction to narcotics and they have to choose between honoring a contract or taking a pill that is readily accesible, the pill is going to win out each time. It is very frustrating to be sure and it can make you feel like your hands are tied and you can't properly do your job....

nhelkhound · May 21, 2011

I had a case where the Pt's daughter told me that someone had broken into their apartment and stolen her morphine. Even showed me where the thief had entered; only problem was that the screen was pushed out from the inside!

SoCalRN1970 · May 21, 2011

I had morphine go missing once.. that I can understand. This was a huge hispanic family who was very anxious and frankly many people in a small house. Giving the benefit of the doubt I ordered a new bottle of roxanol.

Within the next visit The bottle was gone again. I spoke to the dying patients children who lived in the home.. with the multiple family members. I told them point blank, once we can over look that and think it's been misplaced.. it's a small bottle for goodness sake, but a second time out the pharmacy is quesitoning the use or possible abuse of the drug. ( took the blame off of me and put it to another source.. this was true btw. ) The patient was not using the morphine yet and infact I told the family who signed for the cII drug per the pharmacy.

I told them point blank, the pharmcy is concerned about the "loss" of two bottles in a week's time. I also explained that morphine is a class II narcotic hightly controlled and it scared the family enough to be accountable, have one person in charge of the drug and you bet, I did an inventory on it each visit with using a lock box.

Sometimes family will not fess up but know damn well someone took the drugs. I'd never accuse anyone point blank, ti causes resentment and gauranteed will ruin whatever trust there is with anyone.. however, using the pharmacy approach. instilled a fear in the family to be accountable for this "last chance bottle". It never went missing again..

sharpeimom · May 21, 2011

i had hospice for my mom when she was dying of cancer. she had undergone drastic personality changes and didn't want me even in the house. visiting relatives, hospice nurses and aides, visiting friends, neighbors, and my mom's amish cleaning woman were wonderful about keeping me in the loop.

suddenly, meds disappeared mysteriously -- narcotics and sleeping pills mostly. finally, the cleaning woman/friend told me one specific aide was acting strange. i switched pills and took the real ones home with me overnight, when hospice did not want to hear what ___ had old me. sure enough, the bottle of

replaced pills vanished two days later after the aide's shift. finally, she admitted it to the nurse when handed a specimen bottle.

my aunt medicated my mom after that and hospice fired that aide.