What should a director of nursing look for to recognize drug diversion in a timely way?
Lisa Morris, a consultant pharmacist and executive director of clinical services at Consana, recommends parallel approaches. First, look for signs that staff may be abusing substances; simultaneously, look for indications of diversion.
Physical signs of a staff member’s substance abuse can include memory loss, nausea, sweating, tremors or headaches. Behavioral or financial patterns also can signal abuse. Those who divert are often absent after a diversion. When working, they may volunteer to do med pass and insist on administering controlled substances. Look for staff who request off-peak shifts or who arrive early or stay late. Some who divert controlled substances sell them; watch for staff who make disproportionately large purchases.
To identify possible diversion, look for tampering: pills that are taped back in a medication card, changes in liquid medications’ viscosity, or powder on capsules’ outsides. Be alert for quantity loss as well, including missing bottles, cards or liquids. Monitor for poor pain control among residents despite narcotic administration, frequent refills of controlled substances, or frequent apparent wasting of drugs by one nurse or unit.
Closely examine medications at high risk for diversion, including morphine, fentanyl and hydrocodone. Lastly, monitor for differences between count sheets and pharmacy manifests.
Prevention is the key to limiting drug diversion. Have and follow clear policies on controlled substances, including administration and how expired or discontinued medications are handled. Reducing opportunities for diversion will prompt fewer instances that need to be detected.
Please send your nursing-related questions to Amy Stewart at [email protected].
From the January/February 2022 Issue of McKnight's Long-Term Care News
