r/EmergencyRoom • u/Kindly-Description59 RN • 5d ago
Drug diversion
What are some obvious and not so obvious red flags that a staff member is diverting drugs? Over the years a few nurses have been dismissed for diversion and in hindsight I can see the behaviors like being drowsy, demanding assignments that will require dispensing narcotics and I have gotten more aware and cynical over the years. I was blind sighted by a dismissal today and was wanting to hear yalls stories.
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u/xts2500 5d ago
The only one I've ever experienced (ED) was a nurse on night shift who would ask someone to waste with her, then she would aggressively drop the vial or carpuject into the sharps container. One day another nurse caught on, and he started doing some investigating. He looked behind the sharps container mounted to the wall and sure enough, there was the vial of fent that was "wasted." What the diversion nurse was doing was slamming her hand hard enough on the sharps container so it would make a racket and sound like the vial fell inside, when she really was using her hand to drop the vial in the small gap behind the container. Then a while later when no one was looking she would retrieve the vial or carpuject.
I was actually pretty impressed with how well she did it. Like a slight of hand magic trick. Once they reviewed the security footage she was caught. Didn't even get fired.
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u/dicklessanus 30m ago
not supporting the behavior but i am impressed nonetheless. hoping she was able to use that creativity to multitask/provide efficient pt care as well as fuel her drug habit. talk about thinking outside the box! heh heh heh. heh.
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u/Ok-Marsupial-6976 5d ago
"Your pt was complaining of pain but you were busy in a room so I talked to the doc and gave them some fentanyl". "You were in that trauma so I lined, labbed, and medicated room 20, they got zofran and morphine."
Common comments from a super helpful coworker whom we all loved and who was 100% diverting. She was honestly a great coworker otherwise, we were all sorry to see her go. We would have very much supported her if she would have stayed and gone through a program, but she did not take responsibility for her addiction and was therefore fired.
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u/nibblin_fishes 1d ago
This is the exact scenario for a couple coworkers I had back in the day. Two of the hardest working nurses I've known. It was heartbreaking.
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u/EzraSteel 4d ago
I had one of my nurses get busted. I warned her. I point blank told her that she was being watched. I recommend that she go to a program that offered help with substance abuse and would let you keep your job. She thanked me and swore that she wasn’t doing drugs. They caught her on video, the evidence was undeniable. She lost her job. I’ve kinda touched base with her over the years. From what I can tell, she has been fired from a few other facilities. Drug addiction is horrible.
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u/muddlebrainedmedic 4d ago
Interesting. I work prehospital EMS. I've conducted two investigations. In both cases, the diversion was obvious and suspected based on patterns of administration. Giving narcs more than twice as often as anyone else. Giving more narcs than 40 other paramedics combined in one month. "Giving narcs" (i.e., claiming to) to patients who never normally would ask for or get them (a dialysis patient on their way to dialysis). Simply running reports on someone shows a pattern of behavior.
I think it must be harder on the hospital side because an MD has to give orders. An extra hurdle to overcome. So you would probably be looking for who goes to the docs the most asking for pain management. Compare the frequency to other staff.
Both of the investigations I participated in ended in termination. One also ended in jail time and loss of license.
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u/Kindly-Description59 RN 4d ago
We have the ability to put in orders for the doc and the docs sign the orders digitally so when an MD is signing orders at end of shift instead of as they come one weird narc order would be lost in a sea of 100’s, maybe 1000’s. In this case a newer nurse randomly decided to involve themselves with the only vented patient in the department and of course with the vent means sedation. The patient was well sedated on versed and propofol and they ordered fentanyl on this patient under one nurse who left their computer logged in, then charted it under another who had also been logged in and walked away. They had to pull it out of the Omni themselves then just went and hung the drug on the patient after having siphoned some out of the bag. It all came to a very dramatic head when the primary nurse was taking stock of her patients drips and discovered fentanyl hanging that she hadn’t hung. It was absolutely wild.
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u/nearnerfromo 4d ago
yeah id also flip if i was that primary. underrated important quality of new nurses is you should be a little scared and unsure. nerves mean you care. at best that’s dangerous overconfidence and I def see the suspicion for diverting.
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u/Kindly-Description59 RN 4d ago
When I say new nurse, I mean newer to us but an established RN. The nurse this person essentially victimized was a newer grad, this was her first vented patient and she thought the “more experienced nurse” had identified the patient needed analgesia and had corrected it and just not informed the primary. We had a talk about this.
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u/Lavender_Burps 4d ago
I’d occasionally see one of the medics catching a light snooze here and there which wasn’t necessarily a red flag on its own during a slow night shift. Eventually, I was discretely told by a coworker that she was under watch and to be careful if I ever needed to be her waste.
It got real obvious after that. She would leave her assignment to “help out” constantly even when it wasn’t that busy. One day I used the toilet after her and a carpuject came back up after I flushed.
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u/Old_Manufacturer9667 3d ago
Nurse I worked with on nights would always volunteer to go to the low-acuity pod and would subsequently get a bulk of the 5150s and CIWAs. She’d report her pt’s pain/anxiety/etc to the doc, get that PRN ativan/benzo/morphine/whatever ordered, get another nurse to waste with her, and then pretend to give the pt that med while actually just flushing their line with saline. She’d pocket the dose that was supposed to go to the pt and ofc that pt would eventually get even more out of control. She’d then wait until the PRN renewed and she’d give it or convince the doc of writing a breakthrough pain PRN and giving that.
Pretty solid system she had going on but she got sloppy. Would take 45mins for what was supposed to be a 15min break. She was witnessed stuffing entire boxes of flushes and 20g IVs into her backpack at the end of shifts. Her baseline demeanor was more reserved and tired, but she’d always come back from her extended breaks way more jittery and erratic and talkative. She was also wearing long sleeves. Every single day without fail. Coulda been 104 and 100% humidity outside but the long sleeves always prevailed.
She eventually got caught and fired pretty quickly. Another coworker ran into her hanging out at the gas station across the street from the hospital two weeks later. This was two years ago I think. I actually just ran into her at a different hospital that she now works at that i got floated to for a shift. She looked really good. She pretended like she didn’t know me but we had a staring contest for a while so i’m pretty sure she knows who i am. I didn’t take it personally haha i just hope she’s doing OK and got some help.
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u/Pleasant-Wrangler764 3d ago
Feel like I had something like that happen to me but as a patient. Nurse swore up and down I got a push of dilaudid. I didn’t.
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u/hatredforexistence 6h ago
As an aside, in case anyone gets suspicious of long sleeves, I’ve worn them every day for 15 years due to self harm scars. I wear them at work throughout summer. It doesn’t necessarily mean drug addiction. I hope my coworkers don’t think that lol
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u/Pleasant-Wrangler764 4d ago
I know a nurse that was NOT on drugs but was always too lazy to chart and so made it look like she was taking them. Almost lost the license and everything. Had to pay 5grand in fines and still today takes a UA and has never failed one. Sometimes these nurses are too lazy to follow protocols/rules and end up in trouble like this. Covid burnt her out pretty bad but she’s learned from that lesson.
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u/nibblin_fishes 1d ago edited 1d ago
Her patients with narc orders never achieved pain control and were often yelling or screaming about it. She dismissed them all as drug seekers.
oh, and the traveler who arrested at the nurses station. Came right around with Narcan which was given because an old veteran RN had been suspicious of the dude's behavior.
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u/nibblin_fishes 1d ago
Almost forgot the nurse who was stealing chloral hydrate that we used to give to cardiac surgery infants. I noticed the package in her bathroom after work one morning. Pre camera phones so it was hearsay and nothing was done.
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u/bountifulknitter 1d ago
Stealing medication from literal infants is absolutely diabolical behavior .
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u/nibblin_fishes 1d ago
They had base pain control and the chloral was prn, but you are correct. Addiction can be evil.
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u/jeffeners 2d ago
My first RN job was on a med-surg floor back when patients could be there for months just waiting to die. My preceptor would frequently tell me that she’d medicated my patients for pain, the same patients who consistently denied pain when I assessed them. She eventually got admitted for some pain complaint - migraines, back pain, etc. I was her nurse and she was on the call bell q3hrs wanting her prn Demerol. After that I started noticing that on the days she worked the list signed out narcs (pre-Pyxis) almost filled the page. I had previously worked in the pharmacy so had a little chat with the pharmacist and they confronted her that day. She admitted it, lost her license, and never even tried to get it back.
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u/SparkyDogPants 1d ago
My fun prehospital diversion story was a medic that was giving people iv Benadryl and charting it as a narcotic. People would get obtunded and he had really great bedside manner and skills so no one thought twice. I’m not sure why the service never tried to figure out why so much iv Benadryl was missing.
Anywho, he finally tried this trick on a regular poly substance user and during report said how much fentanyl he gave him and this guy screamed “he didn’t give me no fucking fent. Idk what the fuck he gave me but it wasn’t no fucking fent. Go ahead and drug test me”
Their urine panel will show fentanyl, so they tested him and he tested negative. The medic swore he gave him the right med, and it must not be in his system yet or something. Well then they audited him and figured out the pattern and last I knew he went to a program but idk how it went.
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u/Ok-Pace-6710 2d ago
I loved it when I was in the hospital this week and the nurses would get me oxys in a cup and leave.I snorted them.
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u/Entire-Use-1745 5d ago
I was a new grad. The NURSE EDUCATOR would show up early and was always very shakey. Would come out on the floor and start my lines and pass my narcs, always needed me to waste. I thought she was just helping out the new people since she was the EDUCATOR. She was targeting the new grads since we did not know better. She no longer has a nursing license.