Medication Diversion in Long-Term Care
Medication diversion is something we are all aware of, but no one wants to think it can happen in their community. We build relationships with those around us and don’t want to believe that they are capable of stealing drugs and may be under the influence of drugs while working. Drug diversion is something we need to have on our radar so we can act quickly and get the individual the help they need.
What is Diversion?
-Persons (nurses, aide, staff, residents or visitors) stealing medications that have not been prescribed for them to either sell for profit or for personal use.
Why should I be concerned about it?
-It is considered a federal crime and can have strict consequences.
-Most drugs that are being diverted are controlled and have a high rate of abuse and addiction.
-If another employee is using drugs there is a risk of poor job performance, decrease in judgment, and a safety risk to other employees and residents.
-Residents may not be receiving the pain management they require for quality of life and to be able to perform ADLs or participate in therapy.
Prevalence of Diversion:
-The substance abuse rate among nurses is from 2-18% and is the number one reason for a loss of their license.
-900 nurses were publicly disciplined by the licensing board from 2007 to mid-2013 for drug theft and use at work.
-The state of Virginia found that two-thirds of nurses sent into the state health care worker rehab monitoring program cannot or do not successfully complete it. Many of these nurses have been back at work in the health care industry anyway.
Narcotic Diversion: Some signs to watch for:
-People who consistently “volunteer” to give narcotics, “hold” keys or count narcotics.
-Their residents receive more PRN pain medications during their shift.
-Their residents report more non-effective pain relief.
-May work in areas of “high pain med use.”
-Diversion usually happens for residents with high polypharmacy, confusion or more sedation because they are less likely to notice a “bait and switch.” If patients have orders for meds like Benadryl, Vistaril and Ativan they are usually given in place of the narcotic.
-They “forget” to document and/or report lost or wasted meds often.
-Higher doses of a pain med are given when a lower dose is usually effective.
Change of Shift Count - How to detect possible diversion:
-Always use the book to dictate the count instead of referring to the page numbers on the packaging. Books should be numbered.
-Check ALL pages.
-Compare the Rx Numbers. They are the only unique identifying part of each prescription.
-Verify each other’s counts.
-If the directions change, the medication needs to be transferred to another page and rewritten. It is never appropriate to write “See MAR”. Place a copy of the new order with the medication if the directions no longer match the label. It is best practice to order the new prescription.
-Check all bubbles. Tablets should never be taped back into the card. If the foil is tearing, the tablet in that bubble should be destroyed.
-Ensure that there are at least two signatures for each medication destruction.
-Alert your supervisor immediately if the count is not correct.