Could your co-worker be diverting pain meds?
You must take immediate action
An ED nurse recently was arrested on suspicion of stealing fentanyl intended for patients at a Denver hospital. It's not known whether her co-workers suspected the problem and failed to alert management, but unfortunately, that is often the case.
"Many times, ED nurses choose to not recognize telltale signs of a co-worker's challenge. Or, they simply do not know the signs and symptoms or that their colleague has a problem," says Donna Sparks, MSN, RN, CEN, director of emergency services at Baptist Hospital Miami.
If you suspect a colleague is diverting narcotics, Sparks recommends having "an immediate, confidential conversation with a trusted manager." If you fail to act, she says, "the person that suffers could be a patient impacted by the impaired nurse's altered judgment."
"There may arise an opportunity for a nurse to honestly confront a colleague who is stealing painkillers," says Sparks. "Some nurses have extensive experience in addictions and know their organizational policy for getting their colleague the help she needs."
However, in most cases, you should confidentially consult with a trusted nursing manager about suspicions regarding the theft of medications, says Sparks.
According to Sandra Dietrich, RN, MSN, MHA, clinical director of emergency services at the Hospital of the University of Pennsylvania/Penn Presbyterian Medical Center in Philadelphia, your co-worker could be diverting pain medications if he or she:
• frequently offers to give pain medication for co-workers. "It should be the exception, and not the rule, that the primary nurses have co-workers medicate their patients," says Dietrich;
- offers to dispose of pain medication cartridges or syringes;
- withdraws higher doses of pain medication than ordered, so that wastage needs to occur. "If the dose ordered is lower than the medication removed, ask why the higher dose was removed," says Dietrich.
- shows a change in behavior or mental status during the shift;
- frequently needs to use the bathroom, or steps outside of the unit after medicating patients;
- falls asleep during the shift or while documenting;
- displays subtle changes in mood that are blamed on personal problems.
If you suspect a co-worker is impaired, Dietrich says to take these three steps immediately:
- Inform your nurse manager or supervisor about your concerns and observations. Ask them to respond to the unit.
- Ask two co-workers to witness that the employee is falling asleep, preferably including a manager or supervisor.
- Follow your ED's policy on impaired employees. "Once an employee is suspected, the situation becomes an administrative/human resource issue. There are specific guidelines to be followed," says Dietrich.
Sources
For more information about steps to take if you suspect a colleague is diverting pain medications, contact:
- Sandra Dietrich, RN, MSN, MHA, Clinical Director, Emergency Services, Hospital of the University of Pennsylvania/Penn Presbyterian Medical Center, Philadelphia. Phone: (215) 662-3965. E-mail: [email protected].
- Donna Sparks, MSN, RN, CEN, CNABC, Director of Emergency Services, Baptist Hospital of Miami. Phone: (786) 596-7336. E-mail: [email protected].
Follow this process for narcotics wastage One of your emergency nursing colleagues asks you to witness medication wastage, but asks you to sign off without actually observing the wastage. She tells you that it will save time, or that the wastage already was done. What do you say? "As a witness for medication wastage, insist upon reviewing the medication and dose ordered. Then, visualize the wastage," says Sandra Dietrich, RN, MSN, MHA, clinical director of emergency services at the Hospital of the University of Pennsylvania/ Penn Presbyterian Medical Center in Philadelphia. When witnessing wastage of narcotics with a colleague, it is imperative that you diligently follow your organizational policy. Donna Sparks, MSN, RN, CEN, director of emergency services at Baptist Hospital Miami, says, "This must be done for every patient, every medication administration, every time. "Many nurses have enabled their trusted colleague's drug diversions by signing that they have witnessed a wastage when they did not, usually because they were busy and trust the colleague. Nurses are accountable to the profession for following ethical behaviors. This includes the witnessing of narcotic wastage according to policies." |
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