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Newsweek on Addicts Working in Hospitals

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GuEsT78 GuEsT78 (Member)

The latest issue of Newsweek has a disturbing cover story about "When Drug Addicts Work in Hospitals, No One is Safe."

This brief quote from the lengthy article is how it opens:

Gripping the drug-filled syringe, David Kwiatkowski furtively glanced around to confirm that none of his co-workers could see him. Then Kwiatkowski, a radiology technician at Arizona Heart Hospital, darted into an employee locker room, found an empty bathroom stall and locked himself inside.... Minutes earlier, he had snagged one of the syringes nurses preloaded with drugs before leaving them unattended in the operating room. It was labeled fentanyl,” an opiate many times more potent than heroin and Kwiatkowski's latest narcotic of choice.

http://www.newsweek.com/2015/06/26/traveler-one-junkies-harrowing-journey-across-america-344125.html

It's a depressing read, particularly the ease with which he was able to feed his addiction, typically by exploiting loopholes in hospital procedures. It was also easy was for him, caught stealing at one hospital, to find work at another. Coverups were the norm rather than the exception. Only one scheme blocked him:

Maxim—the staffing agency that knew he had been fired from the University of Pittsburgh hospital—placed him at Southern Maryland Hospital in Clinton. While he was there, Kwiatkowski stole no drugs and spread no hepatitis. The reason? Southern Maryland employed the simplest and most logical control over its injectable narcotics: Once drugs were out from under lock and key, the nurse kept the syringes or vials in her pocket until it was time to use them.... The pocket system, Kwiatkowski says, was the only safety precaution that ever stopped him.

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I can give one illustration from my experience as a nurse tech. We were caring for a teen boy who was dying from a large abdominal tumor and getting a continuous infusion of IV morphine. The nurse I was working with sent me to get the boy's next liter bag from the pharmacy. On my way it came to me, "Wait, I'm not an RN. I can't sign for narcotics." I'd seen the sign-offs that were required for even small quantities of morphine. But since I was over halfway there, I decided to continue.

When I came up to the pharmacy window, I explained why I was there, but added that I wasn't a nurse, so I assumed that my trip was pointless. Not so, explained the pharmacist. Once he'd placed the morphine in the bag, he said, the legal requirements were met.

I took the bag and returned to to unit. Had I been an addict and prepared like the guy in this story, it would have been all too easy to stop off in a restroom and remove 100 cc's or so of fluid from the overstuffed bag, with no one being the wiser.

Read the article to discover a host of other ways these precautions are being evaded.

What do you think? Are the drug policies at your hospital effective or are they easily circumvented? Are suspicions aggressively followed up, or is the hospital willing to see those under suspicion slip silently away? How do you think drug controls could be improved?

BrandonLPN, LPN

Has 5 years experience.

Southern Maryland employed the simplest and most logical control over its injectable narcotics: Once drugs were out from under lock and key, the nurse kept the syringes or vials in her pocket until it was time to use them.... The pocket system, Kwiatkowski says, was the only safety precaution that ever stopped him

Maybe I'm just too tired to think this out, but how is this an effective method of stopping diversion of injectable narcotics?

Ty, I thought maybe I was reading it incorrectly.

SWM2009

Specializes in LTC. Has 2 years experience.

Maybe I'm just too tired to think this out, but how is this an effective method of stopping diversion of injectable narcotics?

In the article, Kwiatkowski claims he was able to get access to the injectable narcotics that were prepared and left unattended in procedure rooms or in drawers. So if a nurse kept the injectable narcotic in their pocket then Kwiatkowski would have no access to the medication unless said nurse gave him access I suppose. I guess in his mind it was an effective method to stop him.

This case is sickening...this man went on to work and spread hepatitis C to so many when he could have been stopped cold early on.

Edited by SWM2009
clarification

Maybe I'm just too tired to think this out, but how is this an effective method of stopping diversion of injectable narcotics?

I guess the point is that it's an effective way keeping other staff in the hospital setting (like this radiology tech) from diverting meds. It certainly wouldn't stop the nurse with the pocket of opioids from diverting anything.

This thread reminds of an investigation I did as a psych hospital surveyor in my state many years ago. There was a death by fentanyl OD on the hospital's psych unit, which is what we were investigating. In the course of our investigation, I discovered that one of the RNs had signed out a fentanyl patch for a client who had a legitimate order for the patch, but had signed it out a day earlier than it was due (two days since the last patch instead of three). She claimed it was an innocent mistake, she knew the person was on the patches and she signed it out of the Pyxis before she checked the MAR and realized it wasn't due until the next day, but there was no record that she had returned the patch to the Pyxis when she discovered her mistake (which was her story) and she couldn't come up with any other explanation of what had happened to the stray patch. It was just gone. When I checked with the hospital pharmacy (which is required to monitor narcotic usage throughout the hospital), they said that they checked the daily logs and verified that every person who had a patch signed out in her/his name had an order for a fentanyl patch, but they didn't check to verify that it had been three days since the last patch was signed out. The nurses there could have been signing out a patch every day in the name of clients who were ordered patches, and the pharmacy would never have caught it. Also, the hospital administration seemed surprisingly (to me) uninterested in the fact that a fentanyl patch had gone missing and might have been diverted by this nurse.

In my experience, it's true that hospitals are rather lax about monitoring the controlled substances (until the doo-doo really hits the fam; then, they make a big show of closing the barn door after the horses have already escaped ... :))

Edited by elkpark

weirdscience

Specializes in Critical Care. Has 4 years experience.

Slow news week, Newsweek? Addicts gonna lie, cheat and steal no matter where they are to get that drug of choice. How is this news?

RiskManager

Specializes in Healthcare risk management and liability.

Scenarios in which employees injure or kill patients or spread communicable diseases in the context of drug diversion rank very high on my list of risk management nightmares. Right behind the 'angel of death' events.

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

This is why our anesthesia providers have a Pyxis attached to every anesthesia machine. Any drugs that are drawn up ahead of time are placed into the top drawer and the Pyxis logged out of when leaving the room. Keeps the opportunistic folks away from the drugs (but not those who have sanctioned access to them who are diverting, unfortunately).

RiskManager

Specializes in Healthcare risk management and liability.

In my diversion cases involving physicians and mid-level providers, I would say that 75% of them are anesthesiologists or CRNAs. The drug of choice is Fentanyl.

In my diversion cases involving physicians and mid-level providers, I would say that 75% of them are anesthesiologists or CRNAs. The drug of choice is Fentanyl.

It's been well known for many years (decades) that the highest risk group in healthcare for opioid diversion/abuse/dependence is anesthesia (MDs or CRNAs). I remember hearing about that in the 1970s. I guess some things never change ... :)