Nurses Diverting Narcotics.

[NurseCalamity]

Today I caught a fellow coworker diverting narcotics.... she's an RN with a past history of doing this, but it couldn't be proven, not even with a pop up Urine screening. She had patients complaining about not being given the correct pain pill.... she's basically busted now.... so my question is, have you ever turned a fellow Nurse in for diversion of narcotics and how did it all turn out?

[ktwlpn, LPN]

If someone is hurting badly enough to have a fentanyl patch, stealing their meds is downright hateful!

It's the nature of addiction.....

[lizrn1214]

We had a nurse overdose and die from Morphine we feel she had been re-directing. You get a nurse to witness you wasting the medication in the dispensing machine -- but no one ever watched anyone actually wasting it. I presume she didn't intentionally overdose - but this was years ago and it still affects the department quite a bit.

[dah doh, BSN, RN]

A place I worked at accused a nurse of diverting. They threatened her with sending the DEA over to her house and reporting her to the BON even though they didn't have any proof. Apparently there were 10 norco pills missing. She was on pins and needles for weeks insisting that she had nothing to do with it. I honestly didn't know what to believe so I watched it all play out. Finally, when they opened the pyxis they noticed that the pills were lodged in one of the compartments between the drawers. She never got an apology or anything. She still works there but has since changed jobs out of patient care.

I've heard of that happening a few times on my unit. The pharmacy & management does an audit. If it looks ok, they open up the Pyxis drawers and even pull out the machines to check under it. They don't accuse staff (nursing or pharmacy) just because they were the last person in that narc drawer. They usually find sheets of the missing narcs when they open up the machine.

[Medic/Nurse, BSN, RN]

I've never dealt with this issue. I trust nurses until they give me a reason not to.

A place I worked at accused a nurse of diverting. They threatened her with sending the DEA over to her house and reporting her to the BON even though they didn't have any proof. Apparently there were 10 norco pills missing. She was on pins and needles for weeks insisting that she had nothing to do with it. I honestly didn't know what to believe so I watched it all play out. Finally, when they opened the pyxis they noticed that the pills were lodged in one of the compartments between the drawers. She never got an apology or anything. She still works there but has since changed jobs out of patient care.

Kudos to you for watching it all play out.

Many folks would have have burnt the wheels off the gossip wagon

Had I been that nurse, I might just have invited them to send the DEA to my house, with a entire possé of attorneys (mine). If I'm lucky they will bring the bring the drug dogs (I love animals!) and the Blackhawks too! (Helicopters!) nothing screams DEA response like 10 missing norcos and a "clean" nurse. The DEA is standing by!!!

Also, drug test everyone right then, right there (from pharmacy techs on). Those are serious allegations & threats to send the DEA to someone's house, please? For unsubstantiated crapola? The attorneys would have remained a problem for that hospital regardless of what they finally ever decided about me. Just saying.

I hate high handed admin tricks. But, an entire card of narcs — those would be easy to be stuck in "tighter" PYXIS systems. Tear it apart BEFORE you tear some nurse apart. There should be adequate room in PYXIS systems for items to fit, but often I've had issues with drawers closing cause they are so "stocked". Easy to see that happening.

Bad management.

[nursedorkface]

Yes very common, and nor just nurses, doctors as well... making deals with their patients to bring them back some of the narcotics they prescribed, it's a huge problem and is growing. I don't know how home health works with their narcotics, but eventually anyone abusing narcotics gets caught. It is only a matter of time

I work in home health and except for one case, we always count the narcotics at the start and end of each shift. I do know of a nurse who took the pts. med instead of administering it but the PCG found her drooling and tripping over things so.....

she go bye-bye

[42pines]

I'm only curious, are many of these taken from the patients' due doses? Are they going without?

ETA narcotics were handled differently when I worked in acute, they were more accessible.

As another poster commented, sometimes that is the case.

I actually went to college to become a MT (Medical Technologist) so that I could become CIC (Certified by APIC as Infection Control person). It never worked out, not because I switched to being an RN but rather because APIC required that I had two years of experience of at least 8 hours per week and nobody would let me do it unless I was APIC CIC and I couldn't be APIC CIC until someone would let me do at least 8 hours per week of Infection Control. (This requirement was eventually changed).

But I had studied a lot and read a lot and I remembered one case where the CIC person for a hospital became concerned when she came across half a dozen repeated systemic infections over a two year period--the organism was uncommon, one often found in water and usually not a problem. Eventually she found that all the patients that had become ill had been on a certain IV pain-killer. It turned out that a person in the pharmacy had systematically removed 1cc from 10cc vials and re-injected the 1 cc with tap water. This diluted pain killer was then unsuspectingly infused into patients.

[adm6290]

Absolutely, turn her in. The patients do not need to suffer. However, as a nurse in recovery, I ask you all to abstain from judgement. She is very ill and probably very ashamed. Not excusing what she is doing but always remember that addicts are Ill not bad. This is a mantra for patients and co workers.

[adm6290]

I was so heartened to read your post. In the medical field of all places, we should understand the devastating nature of addiction. No, it does not make the behavior okay but these people are SICK not bad.

I know 2 recovering addicts who did many of these behaviors everyone is discussing. They were very ill and very ashamed. They are now 2 of the best, most caring and empathetic nurses I have ever seen.

what do they do when you have a patient who is an addict? I hope you treat them as Ill as opposed to the attitudes that are being displayed here.

yes, nurses in active addiction need to be removed from patient care. However, how about an attitude of healing and recovery as opposed to condemnation?

[blondenurse12, MSN, NP]

Another is the nurse who volunteers to medicate your patients for pain, or change the PCA, ativan, versed or fentanyl drips. Diverting waste is supposed to be the most common method of diverting drugs.

If your Ativan, Midazolam, Fentanyl, hydromorphone and morphine drips run dry but the pump says the volume to be infused should have lasted for hours, and the amount infused is not consistent with the rate, report it. Check this at the start of your shift. Also check the port on the bag for a hole or drips. Report inconsistencies or pharmacy may suspect you for another nurses diversion. Also be alert to coworkers, patients and visitors who want the curtains closed. This gives them an opportunity to use a syringe to withdraw from the IV bag.

An attitude of indifference, mood swings, irritability, sarcasm and defensiveness, chronic lateness, falling asleep, sloppy appearance, disappearing from the unit, and a deterioration in the quality of work, and doing the bare minimum while leaving an excessive amount of taskwork for the next shift - all of these signs point to diversion.

Definitely spot on. I did not report my co-worker because I never actually witnessed anything other than his odd behavior, but someone else did. He exhibited all of these things. His drips would always run dry and he would leave the unit often on his shift, not necessarily for normal things like running to pharmacy or going to get a snack. He'd be gone for long periods of time. I did once find a needle cap in the staff bathroom which I thought was weird since in the ICU, we never use needles since everyone has central lines. We have them but they rarely get used since most things are meant to be needleless. I guess he was shooting up from syringes he was pulling off the drips.

[subee, MSN, CRNA]

"Odd behavior"along with the other behaviors you mentioned is enough to earn him an admission to the emergency room. Let THEM give the drug screen. We do not have to diagnose nurses with chemical dependencies - we only have to direct them to the experts who can. If you're putting 2 and 2 together, then that nurse is probably very far along in the disease and has already messed out outside of work and is starting to fall apart at work - the last thing to go.