Falsely accused of med diversion

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Hi. I was wondering if anyone has any experience of being falsely accused of med diversion due to giving meds 1-2 hours after pulling them out of the pyxis.

I am so upset and frustrated since my manager recently told me that the pharmacy put me on an alert list for possible medication diversion. The only reason for this is because I have pulled out morphine at times and not given it until 1-2 hours later. There isn't any medication missing. No accusations from patients. NOTHING else.

I am so upset that this is happening. I work on a really busy floor and I often have pulled out a pain med in expectation that the patient will ask for it, though when I go into their room, they are sleeping or don't want it at that time. Rather than return the med immediately, I hold onto it until they need it so I am prepared for the next time. I am on a floor where there aren't any CNAs at times, nor a resource RN and sometimes no unit clerk and every minute counts. I have been beyond frustrated with the work environment and now I am being falsely accused of this. I am trying not to get upset but it's truly difficult.

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You are not accused of med diversion, you have not followed policy. Placing a narc in your pocket can be grounds for immediate dismissal. Review the policy.Pharmacy has a protocol that THEY must follow.

Did your manager write you up for this.. or simply make you aware that you cannot walk around with a narc in your pocket?

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Specializes in Critical Care, Med-Surg.

I would definitely think about changing your practice. It doesn't take long to got to the Pyxis for a med once patient asks for it. Carrying it around in your pocket is just asking for trouble. You could lose it, you could accidentally take it home, someone could see you pocket it and report it, etc, etc.

Our policy here (and I believe this comes from state regulation) is that controlled meds have to be given within 30 minutes of being pulled.

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Specializes in Neuro, Telemetry.

Agreed with the above. How many times have you had things spill out of your pockets when pulling out a pen or bending over or something? Happens to me all the time. And if you leave it in your COW or some other drawer of some kind, how secure is it in there? Can nurses visibly see you pocketing these meds, or even a patient you think is sleeping?

These se things can all lead to you either losing the med or actually being accused of diversion. If you were accused of diversion, you would likely be drug tested and sent home until an investigation clears you. If you were only warned, it sounds like your manager is trying to give you a gentle warning nudge to change your practice. You need to change yesterday. Do not pocket or store anymore drugs in anticipation of needing them later. God forbid it falls out in front of another nurse, or you take it home, or you lose it, you are going to be in a world of trouble.

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Specializes in HH, Peds, Rehab, Clinical.

Sounds like, at a minimum, you ARE guilty of poor judgement and bad nursing practice. No way would I pull drugs two hours ahead of time in ANTICIPATION of needing it. Clearly it wasn't a one time incident either. Change your ways!!

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Specializes in Complex pedi to LTC/SA & now a manager.

There was a poster recently that lost their job and were reported to the BoN & authorities for mishandling controlled & prescription only substances by pulling & "holding" onto narcotics & Benadryl "just in case" in a pocket.

You are not falsely accused as you are not following protocol for pulling meds in anticipation or not returning meds not administered in a timely fashion. Change your practice habits to keep your job and your license.

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Hi. I was wondering if anyone has any experience of being falsely accused of med diversion due to giving meds 1-2 hours after pulling them out of the pyxis.

I am so upset and frustrated since my manager recently told me that the pharmacy put me on an alert list for possible medication diversion. The only reason for this is because I have pulled out morphine at times and not given it until 1-2 hours later. There isn't any medication missing. No accusations from patients. NOTHING else.

I am so upset that this is happening. I work on a really busy floor and I often have pulled out a pain med in expectation that the patient will ask for it, though when I go into their room, they are sleeping or don't want it at that time. Rather than return the med immediately, I hold onto it until they need it so I am prepared for the next time. I am on a floor where there aren't any CNAs at times, nor a resource RN and sometimes no unit clerk and every minute counts. I have been beyond frustrated with the work environment and now I am being falsely accused of this. I am trying not to get upset but it's truly difficult.

To be honest - your facility is right to raise red flags on you as your behavior is similar to people who divert medications. They pull out meds and "hold" them or document as given but take them themselves or take them home. I have known a nurse who would fill the medication vial with normal saline after taking out the narcotics and injected the normal saline while injecting the drug im into herself.

You are not following protocol. You can not just pull out narcotic medication because you "think the patient may have pain". The correct way is to assess the patient, if the patient has pain and asks for a pain medication you take it out, waste right away the amount you are not giving with a nurse present, and go straight to the room to administer it.

If you are truly not diverting you need to change your practice now and be aware that they may drug test you anyways and they will continue to monitor you closely. If you are diverting medication you need to get help.

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Specializes in Pediatrics, Emergency, Trauma.

I don't understand returning the controlled med, even when the unit is busy...

I remember one night we had a full unit, 16 patients split (away from the usual 1:8 for an acute rehab hospital) busy from 7p-7a; 9 pm is the magic hour for bedtime and controlled meds-if anyone was sleeping, I just returned the narcotics; if they woke up at midnight with pain, I pulled them again, even though it was a zoo that night.

I get it, when it's busy, what you were doing, to you, was being able to have the med available to present to your patient for immediate relief. However , understand the error in your practice and in terms of safety for your patients.

I know your aware moving forward you will pull pts meds when you are about to administer them; you will have to prioritize what needs to be done afterwards-if you are able to delegate, so be it, if not during staffing, learn to cluster care and try to be mindful to anticipate who needs meds, what pts may need what supplies if they are having frequent code browns, what can a confused pt have as activities to help prevent a fall, etc., so you won't feel the need to carry meds on your person when your pt doesn't need them; ask for assistance as far as strategies for seasoned coworkers as well.

Best wishes.

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Specializes in SICU, trauma, neuro.

Agreed...and the DEA won't care how busy your floor is. Take the extra 5 minutes to pull med school per policy.

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Specializes in Emergency, Telemetry, Transplant.

Even if I have a pt. who 'always' asks for the PRN right at the moment it is due, I would not pull it out.

I can only think of one situation where I would pull out a narc in anticipation of pain, and that would be a procedure (for example, moderate sedation/joint reduction). Even then, I would only pull out what the doctor states to have at BS, and I know I have witnesses if he give a verbal order during the procedure for the med. It would be right before the procedure that I pull it, and I would waste the unused portion right after the procedure is done.

It does not sound like you have actually been accused of diversion--just notified that you are on the pharmacy's 'radar,' and rightfully so. They are under a lot of pressure to catch instances of diversion, and repeatedly pulling a narc an hour of more before you give it is a definite red flag.

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Just follow policy. I've also been "flagged" by pharmacy in the past ...for scanning a patients' labels (instead of their arm bands) too often when giving IV piggybacks late at night. The patients were well-known to me and would have had to be woken up over and over to be scanned. I thought I was being nice, but it wasn't the safest practice.

They told me to cut it out, and I did. Problem solved.

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She never said she put meds in her pocket or on her person. She might have left them in the patients' med drawers.

I agree that she needs to stop doing what she got flagged for.

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