Tricks of the trade: Diversion- stories of the stupid and sly?

[SuzieVN]

RN drank a bottle of codeine at night, passed out. I called 911.

RN emptied a vila of MS (RED), replaced it with NS (CLEAR). I sent it to be tested.

LPN wrote oders for oxcodone, over the course of a year. Made sure to be there to receive from pharmacy. POA called from out of state regarding a $5000 bill for oxydocone. Told him, no, patient not taking that. Not in chart, not on MAR, not in cart, no trail. Called pharmacy- they faxed me copies of his bogus orders...AND copies of every receipt he signed. BUSTED! (He even slid the original orders into the huge stack for the MD to sign, knowing that they sign anything without looking at it).

Advice: Like the digital age, the pharmacy has all kinds of checks and balances, every pill can be traced. So don't divert, and also never sign you gave a med that wasn't available- you can be found out. Don't do it.

[SwansonRN]

Also be careful about witnessing wastes! You're putting your name on the line. I've heard a story about one nurse that would frequently ask for wastes on IV narcotics. Her behavior became more erratic and finally someone noticed her pinpoint pupils. After being shipped down to the ED they removed her scrubs and found an IV in her shoulder. Think about all those nurses that signed off that they witnessed her properly administer and waste the remaining portion of those drugs! Very sad story.

[SuzieVN]

Army hopspital, watching a surgery, the sedation MD was found to have hep lock is in lower leg- little for the patient, little for him, etc. But I'm hearing that's common, in these posts.

[meanmaryjean, DNP, RN]

I've said it before, and I'll say it again: You don't have to lock up the 'go to sleep' meds around me- you need to lock up the 'stay awake' stuff! :)

And BTW- how do Vicodin addicts EVER poop? Seriously..........

[nurseprnRN, BSN, RN]

Counting one shift, and the little tinfoil cups of cocaine solution felt a little light. Their tamper-proof peel-off covers were intact, though, so we wondered if maybe we were mistaken about how much they should weigh; they were all the same, too. Until one of us noticed the teeny, weeny needle hole in the tinfoil right up under the rolled lip. Every single one.

Our cardiac surg ICU went through dozens and dozens of morphine ampules a day (we drew it up into 1cc syringes to give 1mg/0.1 cc). They came in boxes of 25, and each box had a sheet with the same serial number on it as the box. The sheets were in a binder, most recently started in top. When we opened the box, we signed out those ampules on that sheet; when the sheet was full and the box empty, the sheet went to pharmacy and we got another box and sheet. We had eight or ten of these in the drawer at any given time, with their sheets in the book.

One day the pharmacy was looking through their returned sheets and noticed one missing. This wasn't that odd, because we didn't use the boxes in order, just yanked one out when we needed a new box. But this sheet was a coupla weeks old. So they asked us if we still had it in the drawer (with its box). Oops... both missing. One of our relief charges had taken box and sheet, and it almost never got found. Almost. She came in one Monday soon after and looked awful, said she'd had the flu over the weekend; withdrawal. She went away for awhile and came back with a restricted license. Too bad, because she was an excellent, excellent nurse, and never shorted the patients (unlike some diverters).

[salvadordolly]

Funny story about diversion (b/c most of them aren't) - I worked a pool shift at a free-standing hospice facility. they had their own pharmacist and they didn't count narcs!! this was in the mid 90's. I worked there for a week and we kept running out of Lomotil. I knew when I had gotten the first dose of my shift there was a full bottle. I asked the other nurses if they were using it (it's rare to use Lomotil a lot in hospice) and they said no. I reported it to the manager, who said she would look into it. One of the nurses was accused and fired. A week later, a pick up a pool shift in a private psych/AODA unit on the noc shift and who's there? the pharmacist from the hospice, who tells me he was severely addicted to Lomotil!! I guess they had started counting narcs, so he went into treatment. Lomotil, seriously?

[meanmaryjean, DNP, RN]

Funny story about diversion (b/c most of them aren't) - I worked a pool shift at a free-standing hospice facility. they had their own pharmacist and they didn't count narcs!! this was in the mid 90's. I worked there for a week and we kept running out of Lomotil. I knew when I had gotten the first dose of my shift there was a full bottle. I asked the other nurses if they were using it (it's rare to use Lomotil a lot in hospice) and they said no. I reported it to the manager, who said she would look into it. One of the nurses was accused and fired. A week later, a pick up a pool shift in a private psych/AODA unit on the noc shift and who's there? the pharmacist from the hospice, who tells me he was severely addicted to Lomotil!! I guess they had started counting narcs, so he went into treatment. Lomotil, seriously?

That's seriously messed up. Lomotil? NOW I've heard it all.

[Streamline2010]

That's seriously messed up. Lomotil? NOW I've heard it all.

+1 And they fired a NURSE! for it, too. Imagine that.

[DawnJ]

You gotta poop sometime! But according to my drug book, if you mix it with ETOH or barbituates, you get a better high.

[SuzieVN]

You gotta poop sometime! But according to my drug book, if you mix it with ETOH or barbituates, you get a better high.

Chances are he was snorting it. I've never seen a patient become 'high' from Lomotil, even after many doses. Doesn't even seem to work well for the runs. Fun fact: belladonna drives from'beautiful woman'- the drug dilates pupils, and women used to take it for that reason alone, it was considered a thing of beauty to have dilated pupils. Some people will snort anything- I've heard Prozac is favored that route, on the street?

[RNewbie]

Funny story about diversion (b/c most of them aren't) - I worked a pool shift at a free-standing hospice facility. they had their own pharmacist and they didn't count narcs!! this was in the mid 90's. I worked there for a week and we kept running out of Lomotil. I knew when I had gotten the first dose of my shift there was a full bottle. I asked the other nurses if they were using it (it's rare to use Lomotil a lot in hospice) and they said no. I reported it to the manager who said she would look into it. One of the nurses was accused and fired. A week later, a pick up a pool shift in a private psych/AODA unit on the noc shift and who's there? the pharmacist from the hospice, who tells me he was severely addicted to Lomotil!! I guess they had started counting narcs, so he went into treatment. Lomotil, seriously?[/quote']

What ever happened to the falsely accused nurse? It's not like you could go back and tell the manager you saw the pharmacist in rehab. Poor nurse.

[MN-Nurse, ASN, RN]

Also be careful about witnessing wastes!

The diverters get pretty good at it. I had an instructor who was duped by a coworker who kept fake med vials in her pockets and was extremely good at pocketing the real med, switching to the fake one and "wasting" it.

She would then keep the "waste" for herself and give the patient a lower dose (eventually none) of the actual med.

I don't use narcotics but one could easily do this if he or she saved carpujects. Just palm a carpuject vial filled with water, pull a real one out of the pyxis (right in front of a coworker if necessary) insert the palmed one into the device, spray the fake med into the trash during the waste.

Usually coworkers only witness the wasting of the contents and not the actual pulling of the meds so you don't need to be Penn & Teller to fool anyone.