Nurses Diverting Narcotics.

frisky · May 23, 2015

Wow! Sorry this is happening. Where I work they did catch an RN who worked with us for 5 years stealing narcotics. The story goes she was hiding syringes of liquid morphine and dilaudid in trash cans and one of our aides found them. The DEA became involved and she lost her license. The really sad thing is that she was stealing the medication from terminally ill patients and lying about giving the meds to them. I can feel sorry for her because she has an addiction, but do not feel sorry for her because she was stealing from our patients who entrusted her to care for them. I felt she got what she deserved for this offense and I am glad she is no longer a practicing nurse.

subee, MSN, CRNA · May 23, 2015

This is the reason I will only ask certain nurses to waste with me. I want to waste with someone who will watch the entire process and not feel slighted when I watch the entire process.

How does a witness know what you're wasting. Any decent addict would have emptied the liquid in a vial and replaced it with water. Technology will help us in the future like litmus papers that will indicate whether the drug was actually a narcotic or not, but until then, witnessing wastes is a waste of time.

bluegeegoo2, LPN · May 23, 2015

I have reported, twice. One was a nurse who had just come off of monitoring for diverting Dilaudid. She worked nights, I worked days. We had a resident that had a PICC who was ordered Dilaudid after this nurse was hired. Go figure. This nurse routinely "forgot" to have another nurse witness waste, as well as "accidentally dropped the carpuject and ran over it with the cart." Uh huh. Anyway, she was eventually termed after a med cup full of narcs was discovered in the cart after her shift. Guess she "forgot" they were there.

Anyway, the 2nd nurse I reported had an interesting pattern going in the narc book. Quite a few residents allegedly rec'd PRN narcs on a very obvious Q4hr basis, and only on her days on. So, the book read that all of these residents got narcs q 4 hrs x 4 days the nurse was on, and not one single PRN narc on her 2 days off. Rinse and repeat for weeks. What finally cost her her job was that the count was way off on MSO4. Management couldn't prove that the 4 days on, 2 off schedule was an actual diversion though they knew better. She finally gave them the proof that they needed. (Never mind that she failed the pre-employment drug screen the first time around.)

dirtyhippiegirl, BSN, RN · 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?

That's...kind of offensive. Just throwing that out there.

Libby1987 · May 23, 2015

That's...kind of offensive. Just throwing that out there.

Didn't mean to be offensive but how is it?

I've never posted a negative thing about my coworkers but read endless posts of accusations.

It just seems to add up to a lot of negative categorizing of nurses going on.

icuRNmaggie, BSN, RN · May 23, 2015

How does a witness know what you're wasting. Any decent addict would have emptied the liquid in a vial and replaced it with water. Technology will help us in the future like litmus papers that will indicate whether the drug was actually a narcotic or not, but until then, witnessing wastes is a waste of time.

If hospitals would provide the necessary support, nurses might actually be able to witness waste when the med was withdrawn from the pyxis. A charge nurse should be available for witnessing narcotic waste. It is also really inconvenient when the med room is located far from the nurses station in a large ICU or ED.

I don't know how many times I have had no choice but to remove a 2mg dilaudid carpuject when all the patient needed was 1mg because no one was available to witness narcotic waste. Then I would have to ask a coworker to witness the waste at a later time, or vice versa, I am witnessing the waste of something in a syringe for a total stranger who may have easily diverted the medication. If audited, it would look suspicious that we did not waste the drug when it was removed from the pyxis.

Rather than stock 1mg doses of dilaudid and versed, hospitals stock 2 mg doses. The lower doses are available from the manufacturer. I have asked about this and I was told that "there isn't enough room in the pyxis to stock both." Having to waste narcotics constantly is not an efficient use of a nurse's time, especially in very busy understaffed units.

These are systems problems that lead to nurses becoming lax about witnessing narcotic waste and that make it very easy for a diverter.

dirtyhippiegirl, BSN, RN · May 23, 2015

Didn't mean to be offensive but how is it?
I've never posted a negative thing about my coworkers but read endless posts of accusations.
It just seems to add up to a lot of negative categorizing of nurses going on.

You just lumped in catty nurses and the chronically late with addicts -- and deemed the whole lot to be not upstanding citizens. Unless you were making a joke and I didn't catch the tone, you are making some sweepingly negative categorizations...

Libby1987 · May 23, 2015

I'm sorry I offended but I consider diverters to not be upstanding citizens let alone nurse citizens. That obviously doesn't include everyone with addictions and I inaccurately tied it in when you posted the percentage.

(I do think there are a lot of exaggerations re the other negative accusations and get tired of all of the claimed infighting).

icuRNmaggie, BSN, RN · May 23, 2015

I have only worked in one ICU that had these locked IV boxes available to deter drug diversion.

It seems to me that if narcotic diversion and narcotic waste diversion affected a facility's profits, hospitals would be incentivized to hire more nurses, upgrade their equipment and add a supplemental dispensing unit to the pyxis.

I suspect that the profit margin is higher if the patient is charged for 2 mg of IV dilaudid, even if half of that is wasted.

dah doh, BSN, RN · May 23, 2015

I've heard of a few diverters in my years, both caught by pharmacy audits. The first one was suspiciously over-medicating on his shift only per the documentation. I had to make a witness statement about how much I medicated the patient versus his version of events. He ended up quitting before my facility formally charged him. I feel bad for his family since he had an infant at home.

The second one was recent. He stole an increasing amount of IV narcs from every patient on the unit over the last 6 months per the audit. He was also starting to show medical problems at home and work. He also quit before he got charged.

The last one was one my hubby dealt with. A friend would be chatting with him and other staff, look over your shoulder to obtain your Pyxis password & login; then steal narcs in your name. He finally got caught luckily. Our Pyxis converted to fingerprint scanning afterwards.

NurseCalamity · May 23, 2015

It's not necessarily that I don't "trust" anyone, but I don't trust anyone enough to not watch the waste and sign off on it, because if something comes up missing, and I signed off, I'd look involved in it. I have MY LICENSE to protect and it's more important than covering for an addicted nurse. I hope she seeks the help she needs, because she is a fabulous nurse and has taught me a couple of things. I even waste used Fentanyl patches with another nurse. Anything to cover my butt, I do it. It makes me sad that diverting is very alive and well. That is the side of nursing I did not wish to see in my first year of nursing, but I did. The reality of nursing is that there are good and bad nurses, there's no other way you can cut it.... I thought about just not even saying anything at first, but my conscience ate at me so bad that I had to! My supervisor told me "If you were the one diverting, you think they wouldn't throw you under the bus?" She was right, they would so why should I cover for anyone? Im not an addict, I have no desire to steal medication and I don't know what it is like. But I am empathetic to the nurses who do face this issue, it's very real and very scary.

Dranger · May 24, 2015

I must admit I rarely watch wasting, I sign my name on the pyxis and jet out because I have other things to do. Then again I never sensed my coworkers diverted.