should i report a patient who is diversion drugs?

With that in mind, here are the steps you can take to report suspected drug diversion: First: Report the incident to the healthcare worker’s supervisor or employer. Tell someone in charge, such as a clinical supervisor, department head, or, when possible, the healthcare facility’s drug-diversion team.

Full Answer

What pharmacists should know about drug diversion?

Pharmacy has the lead on stewardship over meds, so that’s why they are often driving evaluation and adoption of these tools. Drug diversion monitoring ... wants to know how much of the drugs ...

How to detect drug diversion in a facility?

REFERENCES

1. Brenn BR, Kim MA, Hilmas E. Development of a computerized monitoring program to identify narcotic diversion in a pediatric anesthesia practice. ...
2. McClure SR, O'Neal BC, Grauer D, Couldry RJ, King AR. Compliance with recommendations for prevention and detection of controlled-substance diversion in hospitals. ...
3. National Institute on Drug Abuse. ...

What are signs of drug diversion?

Signs and Behaviors associated with substance use disorder and drug diversion. expand all. Impairment. Behaviors. Severe mood swings, personality changes. Frequent or unexplained tardiness, work absences, illness or physical complaints. Elaborate excuses. Underperformance. Difficulty with authority.

What do you need to know about drug diversion?

• Changes in job performance;
• Absences from the unit for long periods;
• Multiple restroom breaks;
• Arriving late/leaving early;
• Excessive errors, including medication errors;
• Subtle changes in appearance that may escalate over time;
• Increasing isolation from colleagues;
• Inappropriate verbal or emotional responses;

More items...

What happens if a nurse is accused of drug diversion?

You may be fired for failure to comply, but here's a news flash: if you're suspected of diverting, you're going to be fired anyway. Protect yourself and do not give the employer or the future BRN investigation all they need to unequivocally prove diversion.

How do you manage and report cases of drug diversion?

By email to DEA106@dca.ca.gov, By fax to (916) 574-8614, or. By mail to: 2720 Gateway Oaks Drive, Suite 100, Sacramento, CA 95833.

What to do if coworker is diverting drugs?

If you suspect a colleague is diverting narcotics, Sparks recommends having "an immediate, confidential conversation with a trusted manager." If you fail to act, she says, "the person that suffers could be a patient impacted by the impaired nurse's altered judgment."

How can you tell if someone is diverting drugs?

• Patients who intend to divert medication often refuse a physical exam and are unwilling to give you permission to access their past medical records or contact their previous providers. If pressed, they may say they can't remember where they were last treated or that the provider has since gone out of business.

What happens when a nurse diverts narcotics?

Diverting Drugs: BRN Investigations An impaired nurse, when accused of misappropriating controlled substances, can face criminal prosecution, civil malpractice actions, and disciplinary actions against his or her RN license by the California Board of Registered Nursing (BRN).

How does drug diversion affect patients?

In every organization, drug diversion is a potential threat to patient safety. Risks to patients include inadequate pain relief and exposure to infectious diseases from contaminated needles and drugs, compounded by potentially unsafe care due to the health care worker's impaired performance.

What to do if you suspect a nurse in under the influence?

What to do if a Nurse Suspects another Nurse is abusing? The first step the nurse must do to be able to report an impaired health care provider is to be able to recognize the signs or symptoms and be educated in substance abuse. Many nurses fear reporting a colleague because they worry about retaliation.

What is the role of the nurse manager when a nurse is suspected of substance abuse?

The nurse manager's role in the process of removing the nurse from patient care is essential. Removal from practice will assist the nurse in focusing on care and treatment of the disorder, but more importantly, the earlier SUD is identified and the nurse is removed from patient care, the sooner patients are protected.

How do you tell if a nurse is diverting drugs?

Diversion DetectionObservation of unusual behavior by colleagues.Reports of items, such as sharps containers, being out of place.Large numbers of rejected verbal orders.Complaints of unrelieved pain by patients.

What is required in an organization when drug diversion is suspected?

Suspected Drug Diversion Should Be Reported to the Following Organizations: If Controlled Substances are missing: Send the Drug Enforcement Administration (DEA) a completed DEA-106 Form, Report of Theft or Loss of Controlled Substances within 24 hours that the missing drugs were discovered.

What happens when a nurse has a substance abuse problem?

Once a substance abuse disorder is suspected, the nurse is typically placed on leave until an investigation can be conducted. The nursing leadership team and human resource leaders are required to, in most states, report the abuse to the Board of Nursing (BON) and the local police authority.

What is considered drug diversion?

Drug diversion is the illegal distribution or abuse of prescription drugs or their use for purposes not intended by the prescriber. [1] Prescription drug diversion may occur at any time as prescription drugs are distributed from the manufacturer to wholesale distributors, to pharmacies, or to the patient.

Why is suspected diversion reported to the licensing board?

It is key that suspected diversion be reported to the respective licensing board so that the board can undertake its own independent investigation. Patient harm is a primary consideration in any investigation, and, if confirmed, must be reported to appropriate state and federal agencies as quickly as possible.

What is the task of a diversion investigator?

The task of the diversion investigator is to detect diversion as soon as possible after it begins. Most institutions use a monthly statistical comparison to flag potential misuse. Although useful, remember that such reports can produce both false-positive and false-negative results.

Why is it important to report diverter to outside agencies?

Reporting to outside agencies is necessary for regulatory compliance and essential to prevent the diverter from doing further harm at other institutions.

Why is substitution the most pernicious diversion method?

Substitution is the most pernicious diversion method because it results in denial of needed medication to a patient and may entail a risk of transmission of blood-borne pathogens from the diverter to the patient. Diversion via substitution may occur at the ADC, at the bedside, or anywhere a drug is in transit to the bedside. Diverters may access cabinets through null transactions or purported cycle counts and then substitute the contents of vials or syringes. In several cases, particularly within procedural areas, substitution has occurred when medications were laid out in preparation for administration.

How to conduct a diverter interview?

If the team anticipates that the interviewee may become belligerent, a member of security may be present as well. Ideally, the manager is someone the suspect regards as a supporter, allowing the suspected diverter to feel there is an ally in the room. The person leading the interview should have a solid command of the gathered data and be experienced in questioning a suspect. Conduct the interview in the least confrontational manner possible, but have available all relevant information detailing the reasons for suspicion. The conversation should begin with a presentation of the data. Interviewees often respond with statements such as, I medicate my patients when they are in pain, and I’m just not good at documentation. The diversion specialist should be prepared to respond with more specific information to rebut the suspected diverter’s claim.

What is diverter in medicine?

Diverters typically begin with diversion of small quantities of a particular drug using methods they consider harmless to patients. Theft of waste is one of the most common initial methods. Diversion from waste can take the form of:

Where does diversion occur?

Diversion may occur wherever controlled substances are found. Obvious locations are in the pharmacy and from ADCs, but the list also includes transportation carts, patient rooms during administration, in the hands of nursing staff before and after administration, and waste and sharps containers.

What is the role of the CDC in the investigation of drug diversion?

CDC and state and local health departments have assist ed in the investigation of infection outbreaks stemming from drug diversion activities that involved healthcare providers who tampered with injectable drugs.

What is it called when a patient steals a prescription?

Puts patients at risk for healthcare-associated infections. When prescription medicines are obtained or used illegally, it is called drug diversion. Healthcare providers who steal prescription medicines or controlled substances such as opioids for their own use put patients at risk. This can result in several types of patient harm, including:

What is the denial of pain medication?

Denial of essential pain medication or therapy. Risks of infection (e.g., with hepatitis C virus or bacterial pathogens) if a provider tampers with injectable drugs. Addiction to prescription narcotics has reached epidemic proportions and is a major driver of drug diversion.

How can you detect drug diversion?

Detecting drug diversion can happen only when proper controls are in place. Securing controlled substances means inventory must be managed via various monitoring systems, such as ADCs, locked cabinets, pharmacy vaults, and periodic counts.

What is drug diversion in nursing?

Drug diversion is a felony that can result in a nurse’s criminal prosecution and loss of license. “If patients are harmed, a nurse may risk permanent exclusion from working in healthcare,” New says.

What are the barriers to proper wasting in nursing?

According to Barb Nickel, APRN-CNS, CCRN, CRNI, member of the Infusion Nurses Society (INS) Standards of Practice Committee 2021, barriers to proper wasting include interruptions, need for efficiency (for example, pulling a medication ahead of time), lack of supplies in the drug room (for example, no dedicated controlled substance waste container), being too busy, the inability to find someone to witness waste, and the actual time it takes to waste. When confronted with these hurdles, nurses may create work­arounds or deviations from best practice with the intention of maintaining quality patient care despite the snag. “But once a workaround is allowed, you’ve created a bad practice,” Nickel says.

How can drug diversion be prevented?

“One profession can’t address this alone,” she says. When nursing and pharmacy departments collaborate, drug diversion can be better prevented, reducing the need for detection. Pharmacy departments should focus on providing the smallest incremental dose and multiple dosage forms, so there’s no need for nurses to waste.

How long has drug diversion been around?

Since 1983, according to the Centers for Disease Control and Prevention (CDC), drug diversion has led to dozens of outbreaks of Hepatitis C and other bloodborne infections. These are the incidents we know about. Recent reports suggest that many drug diversion cases in healthcare organizations remain unreported.

Why is awareness and recognition of drug diversion important?

Awareness and recognition of drug diversion are first steps to prevention because “it’s happening in every organization ,” says Ann Koeniguer, RPh, pharmacy operations manager at HCA Midwest in Kansas City, MO. Prevention starts with expecting to see diversion wherever controlled substances exist.

What are the outcomes of drug diversion?

The outcomes associated with drug diversion are disheartening for everyone touched by this issue , especially patients. For example, between June and October 2020, a nurse in a fertility clinic in Connecticut tampered with approximately 75% of the fentanyl given to patients.

What are the implications of drug diversion?

Finally, drug diversion has legal, financial, business and social implications for individuals and healthcare organizations. Healthcare companies can be hit with large, multi-million fines, and damaging new coverage, as a result of diversion within their facilities. Our nation is only starting to address diversion.

What is drug diversion?

Diversion a simple term, but a complex problem. Drug diversion is any incident (s) whereupon a drug is intentionally diverted from its intended destination. But while this definition is relatively simple, the reality of drug diversion is complex: It occurs for a variety of reasons and has a number of health, social and legal implications.

How many healthcare workers divert drugs?

But according to numerous studies, as many as 10 percent of healthcare workers divert or misuse drugs at some point during their career. Even one act of diversion puts healthcare providers, families and their patients at risk for life-altering consequences. Diversion is hard to detect.

What drugs are diverted from the health care setting?

The most common drugs diverted from the health care facility setting are opioids. Although other high-value drugs such as antiretroviral drugs, athletic performance–enhancing drugs (eg, erythropoietin and anabolic steroids), and nonopioid psychotropic drugs have been diverted from the health care facility workplace,7the ensuing discussion focuses on the theft of controlled substances (CSs), defined as medications classified as Schedules II (ie, substances with high potential for abuse) through V (ie, substances with lower potential for abuse than substances in Schedules II, III, and IV), as defined by the federal Drug Enforcement Administration (DEA) and state statutes.8We do not discuss the topic of theft within the pharmacy setting, which is largely accomplished by other means. Typically, drugs stolen from health care facilities are used to support an addiction of either the health care worker (HCW) or an associate and, less commonly, for sale for financial gain. This theft can be of unopened vials; vials or syringes that have been tampered with, resulting in either substituted or diluted dosages being administered to the patient; or residual drug left in a syringe or vial after only a fraction of the drug that has been signed out was actually administered to the patient. In addition, this theft can be of discarded syringes or ampules that have been properly disposed of in a “sharps” safety container.

What is the harm caused by a trusted visitor who volunteered to bathe the patient in order to steal the patient?

In vignette 1, the harm was caused by a trusted visitor who volunteered to bathe the patient in order to steal the patient's opioids. In vignette 2, the patient might easily have brought harm or death to herself by overriding the safety mechanism built into the PCA.

How do addicted HCWs manipulate their colleagues?

Many addicted HCWs become masters at manipulating both the drug control systems in the areas where they work and at manipulating their colleagues so that the addict can divert drugs undetected. Often this involves breaches of policies and procedures on the part of the addicted HCW's colleagues, whereby they unwittingly aid their addicted colleague by “witnessing” the disposal of leftover CSs that they did not witness. This puts the otherwise innocent HCW at risk of disciplinary action for being found in violation of such routine policies and procedures.

Why is surveillance important in health care?

Because of these cumulative risks, it is essential that all health care institutions establish surveillance programs in an effort to detect potential diversion of CSs and implement mechanisms, policies, and procedures that enable quick intervention when diversion is identified, ideally before harm to patients and HCWs can ensue. This is true not only because it is an ethical imperative but also because it is the most fiscally responsible plan for the survival and prosperity of the mission of the health care institution.

How does mandatory reporting affect health care?

Mandatory reporting requirements may cause diversion incidents to become public knowledge and potentially highly publicized in the media. In the long term, this can have a devastating effect on the morale of the employees of the health care institution. It also can have an even more profound effect on the patients and their families who have entrusted their care to the institution, whether or not they were directly affected by an episode of drug diversion. Disappointed or mistrustful patients may seek medical care elsewhere, resulting in financial losses to the institution that, in turn, harm its ability to sustain a mission of providing high-quality patient-centered care.

What happens if you dilute a drug?

If one assumes that the patients required the drugs that were prescribed for them, the absence of the drug entirely or dilution of the drug such that they receive a dosage less than that intended will likely result in the patient experiencing undue pain and/or anxiety, at least temporarily. This pain can be excruciating, as evidenced by the recent diversion of fentanyl by a sedation nurse in Minneapolis, Minnesota.10While the patient was undergoing a surgical procedure, the nurse took most of the prescribed dose of fentanyl for herself, leaving the patient “in agonizing pain.” Immediately before the procedure, this nurse allegedly instructed the patient that he would have to “man up” and tolerate some pain because he could not be given much pain medication. This patient, a law enforcement officer, was so distressed by the care he received that he reported it to the police.10

How many prescriptions were filled in 2010?

In the United States in 2010, nearly 4 billion retail prescriptions were filled, with sales totaling $307 billion. The medication most often prescribed, 131.2 million times, was the opioid hydrocodone combined with acetaminophen.3The opioid oxycodone combined with acetaminophen was prescribed 31.9 million times. Although most of these sales resulted in the legitimate, targeted administration of pharmaceutical agents to patients, a fraction of the drugs manufactured and prescribed for patients are diverted for illicit purposes. Most drug prescriptions are for use in the outpatient setting, and, thus, most diversions of drugs occur there. This problem has been well documented in multiple publications and will not be further addressed here.4Although a relatively small fraction of the nation's drug supply is administered in a health care facility such as a hospital or outpatient surgery center, the nature of these practices provides ample opportunity for drug diversion. This less appreciated form of drug diversion is associated with adverse consequences, the scope of which is incalculable, with harm to the drug diverter and others that is at times horrific. There are no available data that precisely define the extent of drug diversion from the health care facility workplace. However, it is well recognized that anesthesiologists, perhaps more than any other class of physician, have ready access to highly addictive psychotropic medications and have a higher rate of addiction to opioid drugs than physicians in other specialties.5Furthermore, the drugs most commonly abused by anesthesiologists are obtained through diversion.6Such data suggest that ready access is a critical component of drug diversion from the health care facility workplace.

What is drug diversion?

Drug Diversion: Reporting and Liability Issues for Physicians

How many drug classes are there?

According to the Drug Enforcement Administration and the National Survey of Drug Use and Health Data, there are five drug classes with a high potential for diversion and abuse:

What are the recommendations of CMS?

CMS recommendations: • Exercise caution with patients who use or request combination or layered drugs for enhanced effect. • Document thoroughly when prescribing narcotics or choosing not to prescribe. • Protect access to prescription pads. • Keep DEA or license number confidential. • Ensure that prescriptions are written clearly to minimize potential for forgery. • Move to electronic prescribing so paper prescriptions not required.

What is drug diversion?

Definition . Drug diversion can be defined as the diverting of legal drugs for illicit purposes. It involves the diversion of drugs from legal and medically necessary uses toward uses that are illegal and typically not medically authorized or necessary. Adapted from CMS statement, 2012 .

What is the role of a prescription drug dispensing professional?

Assist prescribing and dispensing professionals in identification and prevention of prescription drug abuse; Assist law enforcement and regulatory agencies in the identification and investigation of potential prescription drug diversion; and Promote a balanced use of prescription data that preserves the professional practice of healthcare providers and legitimate patient access to optimal pharmaceutical care

What is a patient with the same diagnosis code?

Patients with the same diagnosis code from the same prescriber or practice; Prescriptions written by prescribers not consistent with area of specialty

Prevention and Detection For Nurses

See more on myamericannurse.com

Diversion’S Scope

Preventing Diversion

Reduce Waste to Impede Diversion

Signs of Diversion

Addressing Opportunities For Diversion

Detecting Diversion

Contributing Factors