It is vital to report those diverting drugs to protect patients and help those with SUD obtain needed assistance ( Stobbe , 2017 ) Keep in mind that anyone can be affected by SUD and the signs can be subtle .
Signs of Drug Diversion Below are examples of behaviors that may indicate a SUD and / or diversion .
• Patients complain of unrelieved pain or state that they didn ’ t receive medications that have been documented as having been administered
• Atypical drug wasting patterns such as heavy wasting lack of documentation related to wasting of drugs that never reach the patient ( for example , patient refusal , discontinued orders ) holding waste until the end of the shift frequent requests for colleagues to sign off on wasting that they did not witness
• Reviewing medication orders of patients not assigned to them , helping colleagues medicate their patients , or volunteering to administer narcotics to patients
• Frequently asking for supplemental orders for controlled substances
• Altering telephone or verbal medication orders
• Changes in job performance
• Recurrent mistakes , poor judgment , variable work performance , blaming others or the environment for errors
• Forgetfulness , drowsiness , malaise , euphoria , anxiety , depression , insomnia , or paranoia
• Deteriorating personal relationships , frequent personal crises , isolation , volatility , or sullenness
• Taking many sick days , arriving late to work , or frequent no-shows
• Extended or frequent breaks and disappearances during shift
• Volunteering for overtime or coming to work on days off
• Arriving late or leaving early
• Inappropriate verbal or emotional responses
• Diminished alertness , confusion , or memory lapses
• Physical signs of SUD , for example , opioid use disorder is associated with constricted pupils , sweating , chills , runny nose , anorexia , itching and scratching , vomiting , diarrhea , or needle tracks .
By : Cynthia Saver , MS , RN , is president of CLS Development , Inc ., in Columbia , MD . n
References American Nurses Association . ( 2015 ). Code of Ethics for Nurses with Interpretive Statements . https :// www . nursingworld . org / practice-policy / nursing-excellence / ethics / code-of-ethicsfor-nurses /
Centers for Disease Control and Prevention ( CDC ). ( 2019 ). Drug diversion . https :// www . cdc . gov / injectionsafety / drugdiversion / index . html
Code of Federal Regulations . ( 1975 / 2021 ). 212 CFR § 1301.91 . https :// www . ecfr . gov / current / title-21 / chapter-II / part-1301 / subject-group-ECFRbf5f8d39b8823bb / section-1301.91
Health Diversion Network . ( N . D ). Reporting suspected drug diversion : How to report ( and why it matters ). https :// healthcarediversion . org / reporting-drug-diversion-how-to-reportand-why-it-matters /
Joint Commission . ( 2019 ). Drug diversion and impaired health care workers . Quick Safety . 48 . https :// www . jointcommission . org / - / media / tjc / newsletters / quick _ safety _ drug _ diversion _ final2pdf . pdf
National Council of State Boards of Nursing ( NCSBN ). ( N . D .) Alternative to Discipline Programs for Substance Use Disorder . https :// www . ncsbn . org / nursing-regulation / discipline / board-proceedings / alternative-to-discipline . page
Perry J , Vandenhouten C . ( 2019 ). Drug diversion detection . Nursing Management . 50 ( 2 ): 16-21 . https :// journals . lww . com / nursingmanagement / Fulltext / 2019 / 02000 / Drug _ diversion _ detection . 5 . aspx
Protenus . ( 2021 ). Diversion Digest . https :// www . protenus . com / resources / 2021-drug-diversion-digest Stobbe S , Crowley M . ( 2017 ). Substance use among nurses and nursing students . J Addict Nurs . 28 ( 2 ): 104-106 .
Cynthia Saver , MS , RN , is president of CLS Development , Inc ., in Columbia , MD , which provides writing and editing services for nursing and allied health publications . She has more than 35 years of publishing experience and is the editor of Anatomy of Writing for Publication for Nurses , 4th Ed .
Georgia Reiner , MS , CPHRM is a Risk Analyst for Nurses Service Organization ( NSO ), which is in the Healthcare Division of Aon Affinity Insurance Services , Inc in Fort Washington , PA . She has worked in the healthcare professional liability insurance business for over 6 years , educating healthcare providers on liability issues and risk management principles .
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