Drug Diversion- Is Your Nurse Doing It?

I was a year into my nursing career and just got hired at a new hospital. It was a huge, Level 1 Trauma center in a big metropolitan area and I was so excited for the new learning opportunities that came with more complex patients. As an experienced RN, I got about two weeks of orientation before taking my own patients independently. On one of my first shifts working on my own, I was doing a routine assessment on my patient. He had an invasive procedure done the day prior and I asked him about his pain level. While doing so, I skimmed through his MAR and noticed he had been receiving two Percocet every four hours. This is why the patient’s response shocked me. He said that he isn’t experiencing any pain at all and hasn’t needed pain medication all day.

What?

Now, it’s not unheard of for some of our hospitalized patients to get a little bit confused. Medication literacy is a big problem in general that we all need to work on. Could it be possible that his day RN was giving him Percocet and he didn’t realize that it was for pain? Unlikely. This particular patient was as sharp as a tack and claimed he hadn’t taken any medications at all since his 9am medication pass. Being new at this hospital, I had never met the day RN before and didn’t know anything about her. Naturally, I mentioned this odd scenario to my night shift coworkers to get their thoughts on what could have happened.

A few days later I was approached by my director and he asked me to meet with him when I got off shift that morning. Thinking this was a routine new-hire check-in, I gladly sat down in front of his desk at 7:35am. He did ask me a few questions about how I was liking my new role and if there was anything he could help me with but then quickly changed the subject to the events of the previous shift. I gave a fact-based description of my conversation with the patient and what I saw in the MAR and then my opinion on the patient’s credibility. I remember my director thanking me but not sharing much else. The next week I learned from other co-workers that the day RN was no longer working there. Rumor had it, I was not the first person to suspect this nurse of unethical behavior.

Why this is a problem: Drug diversion is when a nurse or another individual takes a medication for personal use, sale, or distribution to others instead of administering it to the patient as ordered. Although I certainly can’t prove it, the day RN in question seems to have been withdrawing Percocet under the patient’s profile in the Pyxis, scanning the medication into the electronic health record as though it was administered, and then pocketing the medication herself. Percocet contains Oxycodone, which is an opioid pain medication and it’s a controlled substance.

According to the American Nurses Association (ANA), about 10% of healthcare workers are abusing drugs. Nurses have abundant access to controlled substances and diversion detection and prevention strategies are paramount to patient safety. Response to suspected drug diversion can vary by facility or state but most hospitals would require that the nurse take a drug test. Refusing to do so may be considered a resignation of employment. The nurse’s licensing board should be notified and his or her license may be suspended pending the completion of a substance abuse program. Local authorities may also be notified.

“If you see something, say something” is the catch phrase used at the hospital to encourage reporting safety concerns. Impaired nurses are more likely to make errors, have poor judgement, have erratic behaviors and mood swings, and be less present. What if this was your nurse?

The hospital is a scary place.