Nurses Diverting Narcotics.

Libby1987 · May 23, 2015

Geeze, I'm so naive.

twinmommy+2, ADN, BSN, MSN · May 23, 2015

I have seen several nurses leave employment. One was a friend or so I thought, that was caught by another co-worker after getting meds out on intoxicated patients who wouldn't have known anyway, then charting it, and diverting. Apparently before he came to work here he had his liscense suspended in other states. Then after he left he came back in to be cared for during detox. Just made me sick. I have compassion for pretty much everyone, including addicts, but sometimes it just gets to you.

Dranger · May 23, 2015

I just find it ironic that pharmacy tightly controls little vials of narcotics and benzos but there is barely any oversight for the copious amounts of bags we use on sedated patients.

KJoRN81, RN · May 23, 2015

Yep, I turned the same nurse in TWICE (wrote two statements, copies of MAR, etc).....with no results. It was almost like an "open secret".

Eventually she left & checked herself into a MICU for "detox", but by then I had already found a new position in a place that cares a little bit more. It's disheartening.

"It never gets easier. You just get stronger."

tacomaster · May 23, 2015

Notify your compliance department, it is confidential.

If you're a guy, I would TYPE a note and slide it under their door. I've been screwed over in the past for reporting even though it was supposed to be confidential. The compliance ethics person told my manager it was a male along with my age and ethnicity. Well, there aren't exactly too many that fit my description... Just some friendly advice

Farawyn · May 23, 2015

Geeze, I'm so naive.

Me too. How do you divert a drip? I don't get that.

And with the Pyxis set ups today (as opposed to old school double locks and pill cards) I don't see how it would be easy either.

As a new nurse I once put a perc in my pocket to give to someone and forgot to give it- isolation room, was gowned up, bla bla bla. I got home and found it in my pocket. I was so upset I called work and drove back to return it. Yes, I was written up, but I NEVER did that again.

tacomaster · May 23, 2015

Although I have been absolutely been made a fool of several times by drug diverting nurses, I have noticed some patterns and behaviors that suggest diversion.
One is the "quick waste" when everyone is very busy. The nurse will demand a witness and try to rush the nurse who is the witness. I heard a story about a very rude and intimidating endo nurse who did this and she actually had a secret pocket inside her scrubs. Ask to see the medication before you log on to the pyxis, every single time.
Never pull medication from the pyxis for someone else to administer during an endoscopic procedure. If a procedures nurse knew she did not have access to the pyxis in your area and expects you to just hand over versed and demerol for concious sedation, that should arouse your suspicions. Don't be a pushover.
If the patient is jumping off the table in the Cath lab, or any other procedure, despite repeated doses of concious sedation, suspect diversion.
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.
I worked with a nurse who volunteered to go on every transport and who would withdraw an excessive amount of sedation and analgesia carpujects from the pyxis to take on the transport. She was caught when she overdosed at work.
Frequent discrepancies with po meds in the pyxis and a particular nurse who volunteers to correct the discrepancy with you as her witness, and can do that with very quickly as if she's had a lot of practice doing so. If something feels off, trust that feeling.
Patients who are in distress or under sedated despite repeated documented doses of sedation and analgesia or high rates of IV sedation and analgesia.
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.

Terrific points but specifically the paragraph about verifying and checking the amount in your bags versus time left, etc. In the ICU where I'm at a few of us started noticing that the bags were running dry before they were scheduled to be empty for this one patient last year. The math was correct and the pumps were programmed correctly. We all trust each other other and this had never happened before. So we put our brains together and figured out it was only happening when the sister was visiting the patient and she was an RN. Come to find out she using a syringe to draw out meds from the bags. I had totally forgotten about that until I read your posting. I don't know what happened to her but our hospital reported her to the BON.

Farawyn · May 23, 2015

Tacomaster has answered my question. I guess it's good that I've never heard of that in almost 23 years of nursing. And here I thought I've heard of/seen everything.

SubSippi · May 23, 2015

You should report it...not just for your patients, but for your coworker as well.

Keeping a secret for an addict isn't doing them any favors. If someone has gotten to this point, they are in need of serious help.

featherzRN, MSN · May 23, 2015

We had a drip diverter many years back - he would pull the meds out of the bag with a syringe.

I don't know if they use tubex meds anymore, but back in the stone age I pulled out an almost full box of tubexes and they were ALL empty! (diverters apparently could pull the drug out by sticking a needle through the rubber stopper in the back). This person (never did find out who it was) didn't put anything back IN - if they had, we might never have known. I held that box in my hand and called every supervisor I could find.

Me too. How do you divert a drip? I don't get that.
And with the Pyxis set ups today (as opposed to old school double locks and pill cards) I don't see how it would be easy either.
As a new nurse I once put a perc in my pocket to give to someone and forgot to give it- isolation room, was gowned up, bla bla bla. I got home and found it in my pocket. I was so upset I called work and drove back to return it. Yes, I was written up, but I NEVER did that again.

Libby1987 · May 23, 2015

We had a drip diverter many years back - he would pull the meds out of the bag with a syringe.
I don't know if they use tubex meds anymore, but back in the stone age I pulled out an almost full box of tubexes and they were ALL empty! (diverters apparently could pull the drug out by sticking a needle through the rubber stopper in the back). This person (never did find out who it was) didn't put anything back IN - if they had, we might never have known. I held that box in my hand and called every supervisor I could find.

I guess that's the *honorable* way of stealing drugs..

Libby1987 · May 23, 2015

10% of nurses are addicts? Add in other vices ie chronic tardiness, catty, bullies..what's the percentage of upstanding solid citizens?