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In this paper I will be discussing the prevalence of drug diversion within healthcare and the policies that have been created due to this increasing problem. Along, with aspects of these policies that need to be updated due to constant changes in how healthcare workers attain these controlled substances. Majority of all hospitals have a policy for drug diversion, however many are out of date due to the initiation of medication protocols. However, healthcare works still find ways to obtain these medications for personal use or for a profit.
This in turn not only hurts the hospital but also hurts the patient as they aren’t getting the best care for their diagnosis. We will discuss changes that need to be made to make the policies hospitals and states follow, more strict for those who drug divert.
Drug diversion has become a growing concern within healthcare. While working in the intensive care unit at Hendrick Medical Center by first few months working on nights, I got to see drug diversion within the institution I worked for.
This nurse was diverting Morphine and Ativan for an alcohol withdrawal patient. The aide that was sitting with this patient noticed that he was becoming more irritated. When she went on her lunch break, she spoke with the nurse who said I gave the medications at this time. The aide immediately knew this nurse was lying and she never saw any medications being given during that time. She went to the charge nurse who called our house supervisor and the nurse was asked to come with her, they went down to the emergency department where she was tested.
Once the test came back positive her was terminated and was reported to the board of nursing where her license was suspended and upon investigation was ultimately revoked. This is only one of the few cases that I saw play out while working the other the nurse was found with a syringe full of Propofol who had passed out in the bathroom. She was able to come back and work after completing a drug rehabilitation program the board of nursing approved of.
Liability due to diversions is an evolving issue in health law. Law enforcement and facilities increasingly acknowledge institutional drug diversion, theft of drugs from facilities or patients by healthcare personnel as a problem in the United States (New, 2015). Liability is major concern for hospitals as this can lead multiple lawsuits or malpractice due to patient harm causing by the diversion. Diversion is a multi-victim crime point a significant risk to patient safety, co-workers, institutions, third-party payers, the community at large, and the diverter (New, 2015). Patients are at risk due to multiple actors the first being of course not receiving their scheduled or as needed medications but also because they are being charged for medications they never received, or that the nurse whom is supposed to be caring for them is under the influence. The hospital or institution is at risk because the drug diversion can tarnish the reputation of hospital along with any legal fees. Their co-workers are at risk due to the possibility that this healthcare worker is working under influence and cannot make sound decisions. Therefore, putting all patients at risk as they was under the influence and mistakes can be made easily. Such as witnessing insulin administration or other medications that will require a witness to be administered. The community can also be at risk, as this nurse may get off shift and get high and attempt to drive home and could cause a motor vehicle accident. I remember from when I was in my undergrad nursing classes, we learned about a nurse in Texas who was an operating room circulating nurse. She had an IV in her foot and took unfinished Propofol bottles and saline bags once off shift she would get high. She was ultimately caught when she got in a car accident and the police officer noticed the IV and Propofol in her passenger floorboard. Finally, the diverter is at risk due to possibly implications from the diversion such as addiction, blood borne illnesses and the possibility of losing their license or going to prison.
Many hospitals will discuss drug diversion during a new employee orientation, they will teach the common behaviors of a drug diverter, means of procurement, and administration. Many healthcare workers are unaware that drug diversion is a serious problem in the workplace. Thus, education based on the nature and scope of the problem, signs and symptoms of possible diversion and addiction and proper ways to respond if diversion is suspected (Berge, Dillion, Sikkkink, Taylor, Lanier, 2012). During a new employee orientation, they are given the basics on drug diversion and that it is not tolerable however, they do not discuss the serious legal implications. Healthcare employers should offer their employees education regarding the dangers of drug addiction and diversion meticulous monitoring, documentation, and tracking of controlled substances; assistance for addicted employees; and employee surveillance programs that monitor behavior changes and patients appearing under-medicated (Carpenter, 2014). Once we had the drug diversion incident within the intensive care unit, I worked in the education department stepped up the educational training. They started giving us more strict guidelines on wasting procedures, changing who witnesses our controlled substances, charting. If these policies were in place before the drug diversion incident the nurse may have not had the ability to divert medication leading to a more positive end point.
In the controlled substance policies, we have within the intensive care unit we have a new waste container for narcotics once you waste the medication in the container it becomes unsalvageable. There is also a policy that goes along with it that will keep you from using the same witness over and over during the shift. This has been a way to stop the possibility of a friend covering for the other, so they can divert the medication. There is now a standardized way of charting a controlled substance and they will run reports to see if the medication that was pulled from the automatic dispensing cabinet matches what is charted in the patient’s electronic medical record. They have also placed cameras in the drug rooms to watch any nurse pulling a controlled substance to ensure that proper protocols are being performed. Drug diverters are constantly finding new ways to divert medications and therefore policies need to be updated annually.
Within nursing some of the policies are created by a nursing organization other are created by state or federal governments. Nursing makes up the largest group within healthcare however nurses have historically had little involvement in policy that affects healthcare reform (Brokaw, 2016). Within Hendricks there are multiple teams of nurses that work together in formation of our current policies. However, at the state and federal level this isn’t the case as many policies are created by a third party who may or may not have medical background. I have found it interesting that while doing research for this paper the majority of all nursing organizations have positively backed policies for stricter policy reform for drug diversion. In Texas there was a case where a CRNA diverted fentanyl resulted in 15 patients becoming infected with hepatitis C. He was sentenced to 41 months in a federal prison. While in a different state a scrub tech who diverted fentanyl by substitution was sentenced to 30 years in prison (New, 2015). In the legal ramifications Texas has the one of the only peer assistance programs I have found to where the nurse who is associated with any drug diversion can complete this program and return to work. TPAPN-specific participation requirements are determined by a participant’s case manager in collaboration with the participant’s provider(s)/evaluator(s), treatment provider(s), employer, the BON, etc. TPAPN participation requirements are individualized and based on, and/or adjusted per, a number of factors including but not limited to referral details, participant’s evaluation(s), diagnosis and diagnostic severity, the need for nursing practice monitoring, BON direction, TPAPN participation adherence, recovery progress, etc. (Welcome to TPAPN). I don’t agree with this policy as nurses who have drug diverted can return to work after successfully completing the program and sobriety.
The main aspects to policies regarding drug diversion are that consequences need to federally be standardized across the country. There shouldn’t be a difference among states as to the severity of the consequences. This would show those who have diverted or those who could potentially divert that no matter where they practice the consequences will remain the same. This should include once there is an occurrence of diversion their license should be revoked and if there is harm done to a patient or amount of medication taken jail or prison time should be given. For all division a fine up to $25,000 should be added for any possible implication this would cause the institution or family of the patient. As drug diversion isn’t a victimless crime it causes damage across the healthcare system.
In conclusion, drug diversion is a growing problem and the consequences and policies for such a growing problem need to be strict to ward off any potential threat due to the consequences that will come about their diversion. We as nurses are the backbone of health care and it is our duty to provide the best care and safety of our patients. Nurses should work together in creating these policies so that they match up with our growing healthcare needs.
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