should i report a patient who is diverting 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

Why is it important to examine a suspected drug diverter?

It is useful to examine a suspected diverter’s handling of a particular drug versus other drugs. If doses are damaged or the patient is documented to have vomited medications immediately after taking them, does the suspected staff member repeat doses of all medications or just a particular one?

How do I report suspected drug diversion?

For these reasons, reporting suspected drug diversion is critical to stopping it. 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.

What should I do if someone is suspected of diverting?

If the person who was suspected of diverting is subsequently convicted in a criminal case, or disciplined by their state licensure board: submit this fact to HealthCareDiversion.

What to do if a healthcare worker diverts drugs?

Tell someone in charge, such as a clinical supervisor, department head, or, when possible, the healthcare facility’s drug-diversion team. Be ready to describe the incident (s), behaviors and/or evidence that suggest or support the implication that that a healthcare worker is diverting drugs.

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.

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 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."

Should you report drug dealing?

Drug use or dealing is a crime and should be reported to the police immediately. You can contact the police on 101 or 999 in an emergency.

What to do if a nurse is diverting narcotics?

If the person suspected of diverting is a nurse, pharmacist, physician, or other licensed healthcare professional: Report the healthcare worker to their professional licensure board within your state, such as the state Board of Nursing, Board of Pharmacy, or Medical Board.

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 can you tell if someone is diverting drugs?

Medication diversion is all too common and can be difficult to spot, but look for these signs:Strange stories. Be wary of new patients with stories that don't seem quite right. ... Reluctance to cooperate. ... Unusually high (or low) understanding of medications. ... Strange symptoms. ... Specific drug requests.

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.

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 is the nurse's responsibility when confronted with a colleague who is chemically impaired?

The Code's Interpretive Statement 3.6 states, “The nurse's duty is to take action to protect patients and to ensure that the impaired individual receives assistance.

How often do nurses divert drugs?

Most estimates put nurses' drug and alcohol misuse at around 6% to 10%, or about one in 10 nurses. This makes it highly likely that at some point in your career you'll encounter a colleague or staff member who is, or will, divert and misuse drugs.

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:

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.

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 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.

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:

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.

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.

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.

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 first steps to prevent diversion?

It’s a far-reaching hazard with legal and financial implications that threaten patients, medical facilities, healthcare workers, and the public. Awareness and recognition are the first steps to prevention. Reducing the need to waste medications and properly wasting can help circumvent diversion.

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 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.

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.

How often should pharmacy monitor diversion?

The pharmacy department prints a report that compares ADC activity versus controlled substances safe activity at least every three days, looking for any suspicious patterns. This report allows the auditor to compare the narcotics removed from the narcotics safe to those delivered to the ADC stations, as well as other medications that have been returned or expired. If discrepancies are discovered and cannot be resolved, the pharmacy manager or supervisor is notified.

How do employees respond to diversion evidence?

However, if the diversion evidence is more conclusive, our experience has been that employees respond in one of two ways: they admit they have a problem and ask for help, or they quit their jobs. Our hospital culture supports helping those that admit they have a problem, so these employees are typically directed to our employee assistance program, which usually refers them to a rehab program. Employees are given the opportunity to self-report to the state board of their profession; however, the investigative team follows up to ensure that this happens.

What happens when a pharmacy discrepancy is identified?

When discrepancies are identified, the pharmacy designee contacts the individual anesthesiologist (s) to resolve them. If discrepancies cannot be resolved in this manner or a concern is raised about possible impairment or diversion, the chair of the department of anesthesia is contacted in writing. Nursing.

Why do hospitals need internal audits?

To meet those expectations, facilities should require internal audits to help identify clinicians with unusual dispensing patterns that might be indicative of diverting controlled substances . When unusual patterns are identified the challenging work begins—investigation, and in cases of proven diversion, confronting the diverter and reporting these events to the appropriate agencies.

How to thwart a diverter?

One successful technique pharmacy employed recently to thwart a diverter was to visit a patient who had just been given a controlled substance medication and qualitatively gauge pain relief. The nurse suspected of diverting had signed out two oral pain medications for a patient, but as a result of pharmacy’s discussion with this patient, it was discovered that he had not received any oral medications for pain. The patient did not, however, complain of pain, since he had recently received a parenteral dose of pain medication.

What is diversion in P&P?

Diversion is a significant employee and patient safety concern, and cannot be handled in a vague or unclear manner. To remedy this, we sought to develop a definitive, guiding P&P protocol to ensure all staff members are aware of the steps that should be taken when diversion is suspected.

Who is responsible for making sure a report is filed with the individual’s licensing board?

The investigating manager is responsible for making sure a report is filed with the individual’s licensing board (ie, nursing, medical, or pharmacy). Pharmacy is tasked with reporting to the Drug Enforcement Administration and to the pharmacy director and chief executive officer, per policy.

What is drug diversion in hospitals?

Drug diversion at hospitals occurs in different ways. Employees, including nurses, might be diverting from a hospital’s waste receptacle to support their habits, which is what Garcia did. The next level of diversion, according to Garcia, happens when employees divert opioids or controlled substances from patients.

What is prescription drug abuse?

(1 contact hr) Most people take prescribed medications properly, but many obtain drugs fraudulently, use medications that are not prescribed to them, or use more than prescribed or take them for reasons other than medically indicated.

How long did the pain prescription last for Garcia?

It was a legitimate prescription for the pain, for the surgery, for the post-op, the recovery and the rehab.”. The legitimate pain prescribing lasted for three months — plenty of time for Garcia’s body to become physically dependent on opioids. But even he didn’t know what was happening at first.

What is the next level of diversion?

The next level of diversion, according to Garcia, happens when employees divert opioids or controlled substances from patients. And in some cases, employees divert drugs from the hospital to distribute on the streets or to other people.

What is the most commonly abused prescription drug category?

The most commonly abused prescription drug categories include pain relievers, stimulants, sedatives, and tranquilizers. Drug overdose deaths more than tripled from 1999 to 2015.

Can coworkers identify coworkers suffering earlier?

Coworkers who better understand the problem might identify coworkers suffering earlier — before it becomes a psychological addiction, Garcia said.

Is drug diversion a hidden epidemic?

Drug diversion by hospital employees is a hidden epidemic feeding into the nation’s opioid crisis, according to the report Health Care’s Hidden Epidemic: A Call to Action on Hospital Drug Diversion released in 2019 by medical technology company BD.

What is the responsibility of a healthcare professional?

As a healthcare professional, you share responsibility for solving the prescription drug abuse and diversion problem. You have a legal and ethical responsibility to uphold the law and to help protect society from drug abuse.

What is the responsibility of a physician to prescribe controlled substances?

You have a professional responsibility to prescribe controlled substances appropriately, guarding against abuse while ensuring that your patients have medication available when they need it. You have a personal responsibility to protect your practice from becoming an easy target for drug diversion.

What does "deceives" mean in medical terms?

States that a prescription has been lost or stolen and needs replacing; Deceives the practitioner, such as by requesting refills more often than originally prescribed; Pressures the practitioner by eliciting sympathy or guilt or by direct threats;

What are the signs of drug abuse?

Cutaneous signs of drug abuse - skin tracks and related scars on the neck, axilla, forearm, wrist, foot and ankle. Such marks are usually multiple, hyper-pigmented and linear. New lesions may be inflamed. Shows signs of "pop" scars from subcutaneous injections.

What does "non-narcotic" mean?

States that specific non-narcotic analgesics do not work or that he/she is allergic to them; Contends to be a patient of a practitioner who is currently unavailable or will not give the name of a primary or reference physician; States that a prescription has been lost or stolen and needs replacing;

How to get rid of drug seeking patients?

write prescriptions for limited quantities. "take their word for it" when you are suspicious. dispense drugs just to get rid of drug-seeking patients. prescribe, dispense or administer controlled substances outside the scope of your professional practice or in the absence of a formal practitioner-patient relationship.

What does it mean to be reluctant to give reference information?

Reluctant or unwilling to provide reference information. Usually has no regular doctor and often no health insurance; Will often request a specific controlled drug and is reluctant to try a different drug;

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