in my years of nursing i have personally come acrossed a "few" nurses, drs', anesthesia, nurse manager and 1 pharmacist.
some perhaps seen because i travel to different facilities and so i would not "be" familiar with anyones normal behaviors.
1) nurse- nebraska i was working in the operating room and we had a trauma come into the er, farming machine verses limb. when asking about the vast amounts of narcs given to this patient *(i would want to be gorked out too)* i was getting report with the charge when she started going over who gave what.... 10 mg morphine quk jet was not accounted for. i didnt think anything about it and patient was taken to surgery. ( the nurse over my patient wasnt the charge nurse, the nurse for the patient was not there when i got there so i had no idea other than a name who was the nurse i had to get report and go). i got to work the next morning and there was a note given to me by my charge nurse to go to admin, her note said "random drug screen" ok not a problem. i later found out, all persons whose name er doc, er nurses, all er techs and me along with my anesthesologist. 3, did not pass....... 1 rn, 2 er techs failed the screen. that was my first experience.
2) 3 am call back for emergency appendectomy- i went to the er picked up my patient and took him to surgery family in tow. set the patient up in the room and anesthesia was with me in the er, my tech was there we were waiting on the doc... general surgeon, well known been there for years..... i was told salt of the earth kinda guy. i had worked with him maybe 4 times, (different speciality but when your on call you do it all). we waited for a half hr in the room patient aaox3, medicated for pain per anesthesia...... hour goes by.... i have called him 3 times, each time he stated he was in route...last phone call was pretty short. when he finally showed up. 1 .5 hours post the time he was notified from the er doc about the case. he stuck his head in the door nodded to the anesthesia and instructed us to prep and drape while he washed his hands for surgery. when he came in the room he walked by me to the back table to gown up, as i was tying his gown, he reaked of booze. i asked him ... dr are drunk? loud enough all in the room could hear. the anestheologist jumped up and ushered him right out of the room and within a few minutes his partner showed up and surgery went forward. aparently he was going through a divorce and they had been covering for him. i wrote everything up and went straight to the director with it. it was not the first notice of this issue........ frightening
3) anethesia tech od'd in the surgery lounge on diprovan, roc, ativan, lidocaine, papaverin... all the wasted syringes from the anesthesia red box, all of the above mixed together and self injected.....that happend on the night shift.
i dont think anyone can predict when someone becomes to diverting, it is sad to see the end result though. i have worked in the days where we counted each and every pill, shift by shift one person had the keys and you guarded ith with your life. when the pixis system came in i exhaled thinking it was the fort knox of drugs.... no it seems its the golden gate because i have heard others give thier passwords when they werent close to the pixis and the password just shouted out to whose listening. in surgery its an entire different ballgame. we are privi to so much we look at everyone, question and a smart nurse has anesthesia watch her distribute drugs or another rn, i watch my anesthesia and drs constantly, because that is a time where my patient has no voice.