"Red Flags" of Drug Diversion - page 2
Listmates, My post is intended as a way of "helping" us in our work settings to possibly identify a peer or colleague who might be actively diverting drugs. None of us wants to "rush to judgement"... Read More
Jul 4, '07Quote from kizzykatlovewe had this nurse that was found passed out the bathroom with a demerol syringe in her hand. then we had another one who actually had a Heplock under her shirt and was caught shooting up in a pt's bathroom. neddless to say they no longer have licneses... you work so hard for your license .. why do such stupid things.. idiots.....
Ah......another righteous person.....
Jul 4, '07We had a nurse who couldn't afford prescription meds for herself and they found her pockets loaded with Altace.
Jul 4, '07Quote from motorcycle mamaWhat a sad state of affairs, that people working in health care don't have adequate coverage.We had a nurse who couldn't afford prescription meds for herself and they found her pockets loaded with Altace.
Jul 4, '07Then there are the people who divert a whole course of Abx for themselves or family so they don't have to go get a script filled.
Jul 4, '07I nearly lost my job soon after starting because an entire unopened package of injectable Ativan came up missing. They were delivered to the med frig, which had no lock box. (frig was unlocked as well)
I signed them in and when counting the next morning, they were gone. We tore the place apart, but they were nowhere to be found. No patient had received Ativan during my shift, and after several hours of searching, filing the paperwork and being interrogated by my boss, I finally went home fully expecting to be fired.
Luckily (for me), that same night, another box of Ativan came up missing in one of the units. They eventually tracked it back to the pharmacy tech who was delivering the meds. She apparently had come back to "stock" the med rooms and removed the boxes of Ativan at that time.
Jul 4, '07While this post is helpful, I would like to point out, as someone else did, as well, that not all of these behaviors are indicative of 'drug seeking/abusing' nurses. Maybe taken as a whole, but, especially, for 'new/newer' nurses, it is helpful to realize these are, taken together, possible signs of drug seeking behavior. I would like to point out that, taken individually, #s: 1,2,12,13,20,22,23,25,26,27, 32 and even 33 do not mean the person is a drug user. Even #s: 3,4, maybe 5....are frustrating perhaps to the rest of us, but does not mean the person is off doing drugs.
Again, great post, just wanted to emphasize that it is a cluster or group of these combined signs we would look at.
Quote from WriteStuffListmates,
My post is intended as a way of "helping" us in our work settings to possibly identify a peer or colleague who might be actively diverting drugs. None of us wants to "rush to judgement" on such a critical issue as this. To accuse or even "suspect" wrongfully is a very hurtful place to go for everyone involved.
However, the reality is that our working environment is inherent with accessibility, and availability of addictive drugs that can become a source of temptation for the Nurse who is battling her own demons of addiction.
The "list" of red flags I am proposing is in no way all-inclusive. However, I submit such a "list" from my own experiences as the once impaired Nurse that I was, with the hope that if you see such similar red flags, they are "signals" that might not be ignored.
As Managers, Charge Nurses, and Teammates we never want to "believe the worst" about our colleagues. Addiction is addiction, whether it's played out on the street corner, or within our medical settings, and within our medical settings we find it far more difficult to "believe" this could actually be happening, but it does.
I also submit this information with the hope that, if you suspect a colleague has a problem with addiction, you might find the courage to take the necessary, and proper steps toward intercepting the diversion for him/her, because left unchecked , he/she is not only compromising the safety of patients, but contributing to the progression of the disease. By "intercepting" I simply mean reporting your observations, concerns to the person you believe will be able to help.
This list is not necessarily in any particular "order" of importance, it reflects behaviors that potentially portray an underlying problem, when seen on a consistent basis:
1. Volunteers, frequently, to work overtime, extra days.
2. Uniform consists of a lab coat with pockets or clothing that is loose fitting.
3. Often "disappears" from the unit aside from expected "break times" (meals, etc.)
4. "Nods off" at the desk, or frequently c/o "feeling so tired" lately.
5. Mood changes from quiet and subdued, to suddenly being animated, charming, engaging and confident.
6. Avoids being in the Med Room when others are there, and is observed being alone much of the time (in the Med Room).
7. When alone in the Med Room, and others enter, makes a hastey exit.
8. Often "forgets" to sign out scheduled drugs until the end of the shift.
9. Volunteers to be the one to "make out new narcotic sheets" for oncoming shift.
10. Volunteers to be the one doing the Narcotic Sheet count, as opposed to the cupboard's Narcotic Stock supply at change of shift.
11. Volunteers to give your "prns" for you.
12. Volunteers to go to Nurse's Lounge and make the coffee whenever needed.
13. Has a locker assigned, but rarely uses it.
14. Often has "bruises" on top of hands, and covers them with a bandaid.
15. Appearance of bloodstain (fresh) on uniform pants in thigh area.
16. Her patients who are in pain "never seem to obtain effective relief", or are "still agitated, uncomfortable and anxious" when she claims she has "just medicated" them.
17. Shops for orders for her patients relative to pain medication. i.e., "Dr. So-and-so....the Vicodin is not working for Mr/Ms "X", could we give something stronger" - when the Vicodin had been working all along.
18. Charting reflects having "given" a narcotic injection to a patient on the day of discharge.
19. Writes a T.O. order for narcotics, but never called a doctor.
20. Volunteers to be assigned the sickest patient or patients. (who have narcotic orders in abundance)
21. Frequently leaves out details required on Narcotic Sheets.
22. Is often late to work.
23. Calls in sick more than usual.
24. Ignores, even "jokes" about the necessity of and seriousness of policy and procedure surrounding narcotic dispension and documentation.
25. Pockets multi-dose vials of normal saline (10cc and 30cc).
26. Has a "ready supply" of syringes and needles in her uniform pockets.
27. Is known to never "empty" out pockets of such supplies at end of shift and before leaving the hospital.
28. Gives conflicting information about her patient's degree of pain to oncoming shift. (on "her" shift, the patient was in "great" pain and "needed" medicating either more often, or with larger doses)
29. "Forgets" to tell oncoming shift she "just" medicated patient with a narcotic, and conveniently "forgets" to chart same on med sheet.
30. Is known to "save" partial doses of narcotics (not used), because...."patient might need it later."
31. "Wastes" narcotics without a second witness, and asks you to "please sign" at end of shift - "I was in too much of a hurry and no one was around then."
32. Distances self from management, administration, and others in charge.
33. Rarely asks "for help" from peers with regard to patient cares requiring such help. (prefers to "work alone")
This is an example of what might be observed in behaviors. There are many more I'm sure. I cannot stress enough that delicate place of not rushing to judgement, but at the same time relying on your common sense, caring concern and what your heart and gut might be telling you. If you find yourself in such a position, the better thing to do is take your concerns to even one person you trust, who will know how best to address your suspicions. You have the right and need to express your worries over such serious matters in the work place. An impaired Nurse on duty places her teammates in a very uncomfortable, and compromising position. When handled properly, the outcome for the Nurse, colleagues and patients, can be positive rather than tragic.
Good Management knows the risks that are involved when an intervention is necessary, and should be prepared to deal with the risks. (one being suicide)
I hope this is helpful information. Over a period of three years, I exhibited all of those behaviors, and toward the end, I was screaming (internally) to those around me......."don't you see what I'm doing, please, please stop me; someone help me!" And they finally did, before I could take my own life.
Thanks for "listening."
Bonnie Creighton,RN, MHCA
Mental Health Consumer Advocate
Jul 4, '07Quote from kizzykatloveThere are a BUNCH of recovering nurses here that have done stupid things, this is true but WE ARE NOT IDIOTS.we had this nurse that was found passed out the bathroom with a demerol syringe in her hand. then we had another one who actually had a Heplock under her shirt and was caught shooting up in a pt's bathroom. neddless to say they no longer have licneses... you work so hard for your license .. why do such stupid things.. idiots.....
Maybe you should try learning about the disease of addiction first before name calling.
Jul 4, '07All of these signs can be misunderstood. I am a travel nurse and was accused by a social worker who told my manager she thought I was stealing pt meds. I had been recently placed on seroquel for insomnia. My pcp increased my dose because I was not sleeping. well this increase made it impossible to be awake and alert untill after 11am. I had been c/o being tired and even fallen asleep at the desk. My manager called me in and told me she had been informed I might be stealing drugs. As a traveler I was not comfortable telling my health history to a manager I didnt know and worried about her not extending my contract. I offered to take a drug screen but she declined it. She sent me home for the day and I went to my MD and told him what was happening, he decreased my dose but I decided to be safe not take it if I was working the next day. When I went back to work my manager stated I "looked so much better", I said my meds were changed but I dont think she believed me. I was not extended and it was a great job. It still bothers me to this day to be accused of something and not be able to prove it wasnt true.Last edit by angel4gramma on Jul 5, '07
Jul 4, '07Aadsmom, unfortunately the list does also describe those who are legitimately on medications that alter us.
Jul 4, '07Quote from TazziRNi don't think i understand.Aadsmom, unfortunately the list does also describe those who are legitimately on medications that alter us.
if you're on a prescribed med and it alters your loc, you can be charged w/impairment.....even though it was prescribed???
Jul 4, '07Depends on what it is....if it's something like Vicodin, yes. If it's something you need for maintenance, usually not.
What I meant was, being under the influence of any drug that alters you, you can be suspected of diverting or using. Aadsmom said the points on the list could cause misunderstanding. I was agreeing with her.
To clarify: prescription drugs such as antidepressants and antipsychotics caused alterations but the body adjusts to them......UNTIL THE DOSAGE IS CHANGED, such as in Aadsmom's case. Until the new dose is adjusted to, an observer can notice changes.Last edit by TazziRN on Jul 4, '07