A nurse under stress pulls drugs without an order and pockets them for personal use. A stressed-out surgical technician switches out powerful pain medication, leaving saline-filled vials behind. These are just two examples of what drug diversion, a dangerous problem plaguing the nation's hospitals, looks like.
This occurrence can negatively affect patients in a myriad of ways. For instance, they may not receive proper pain medication or could be put at risk of infection because someone tampered with and inappropriately used a container.
Drug diversion has been a hot topic of late. For instance, one former surgical technician was caught diverting drugs at Englewood, Colo.-based Swedish Medical Center earlier this year, potentially putting roughly 2,900 patients at risk of infection. That incident caused at least four other hospitals that previously employed Mr. Allen to warn their patients they may be at risk of infection as well.
Kimberly New, JD, BSN, RN, the founder of Diversion Specialists, spoke on the topic at the AORN Surgical Conference & Expo in Anaheim, Calif., on April 3. She says drug diversion isn't just a patient safety issue; it also puts the hospital and its surrounding community at risk.
For instance, drug diversion can happen at any hospital, anywhere, and a hospital's reputation is at risk if an incidence of drug diversion becomes publicly known. Additionally, drug diversion puts hospitals at risk for lawsuits and low morale, not to mention the possibility of a staffing shortage and the expense of hiring and training new staff.
On top of that, when impaired employees get off of a shift and drive home, the community is at risk because of the dangers associated with those employees driving under the influence.
Ms. New stressed that anyone could be a drug diverter. "You cannot look at someone and discount [that] they might be diverting," she said. However, she listed several common characteristics and behaviors drug diverters seem to share, including the following.
- High-achieving employees. Most managers believe that drug diverters are more likely to be sloppy workers, but this isn't the case, according to Ms. New. Instead, the offenders are more likely to be the "nurse of the year" type and beloved by medical staff.
- Stressful personal life. Perhaps the person has been acting erratically, but everyone on staff attributed it to personal stress, like a divorce or other significant life event.
- Agency or travel worker. "That's not to say that [travel nurses] are bad," Ms. New said, but often people with a history of diversion are drawn to that type of work, as they can divert smaller amounts from multiple hospitals where they work, and a travel agency may not vet its nurses as stringently as a hospital or surgery center would.
- Disappear frequently on shift to use in the bathroom, and they may come out with blood on their scrubs.
Key components of a diversion diversion program
Just because the problem is widespread in American hospitals doesn't mean it has to stay that way. "Everyone needs a diversion program," Ms. New said. "We know this [drug diversion] is going to happen."
She suggested having a designated diversion program manger — it doesn't have to be a full-time position, but this person should have enough time to devote to education and adequate auditing, and be a consistent resource for people in the organization.
Further, hospitals should have a solid method of auditing medication and acting quickly when suspicious data is found. "If we have a suspicion, [we] need to pull the person" and talk to them, Ms. New said.
Education is also paramount, of both clinical and nonclinical staff members. In fact, environmental services employees could be the first to sound the alarm of suspected drug diversion due to, for example, a syringe found in a toilet or other evidence in a trashcan. At the very least, leaders need to make clear that all staff has a responsibility to report potential diversion.
Finally, hospitals need to make sure they are providing emotional support and intervention for nurses and other staff who are struggling with stress, as stress can lead employees to start using opioids and possibly resort to diverting them. "We need to recognize we're all at risk," Ms. New said. "Make sure staff know the resources and keep coworkers responsible."