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Taking steps to prevent drug theft

Nurse Leader Weekly, June 18, 2004

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Taking steps to prevent drug theft

A former nurse at Sioux Valley Hospital in Sioux Falls, SD, accused of taking her patients' medicine and using it herself pleaded not guilty on June 1 to two counts of misrepresentation to obtain a controlled substance, according to the Argus Leader newspaper.

Authorities say the nurse, Jessica Jo McMahon, 35, checked out doses of Demerol and Dilaudid last December and kept them for herself, the Leader reported. Court papers say McMahon was forced to resign and voluntarily turned in her nursing license. If convicted on both counts, she faces up to 20 years in prison and a $20,000 fine, the paper said.

Donald Bogardus, MPA, CHPA, CPP, who has conducted drug investigations at hospitals for more than 20 years, says the two main methods of drug diversion are charting and substitution, with the most widely diverted narcotics being Fentanyl, Demerol, and Morphine. Bogardus spoke during an October 2002 audioconference entitled "Drug theft in the healthcare setting: How to identify and tackle the problem," sponsored by HCPro, in Marblehead, MA.

He suggested the following prevention steps:

1. Put a policy and procedure in place that everyone knows, agrees with, and follows, stated Bogardus. A substance-abuse policy should consider legal, ethical, professional, and financial issues.

"The real danger to patients or coworkers comes from inaction on the part of those who notice these behaviors. Denial or apathy can create a situation where an entire department is aware of a problem but refuses to address it, especially in this time of nursing shortage," concurred Diana Quinlan, CRNA, MA, chair of American Association of Nurse Anesthetists Peer Assistance Advisors Committee in Jacksonville, FL.

2. You need to identify potential abusers. Bogardus suggested that staff become aware of the warning signs of drug addiction among other staff members. Rapid mood swings, taking on extra shifts, memory loss, wearing long sleeves in warm weather, and patient complaints of ineffective drugs are good signs that drugs are being diverted.

3. Look for warning signs within your patient charts. Some charting red flags are extra-large doses; odd patient names; and dose, time, and date errors.

4. Implement proper safety precautions so your hospital's narcotics are not easily available to abusers. Suggestions include implementing an electronic method of narcotic access that requires fingerprint identification and card swipe identification, removing and inspecting Fentanyl patches from boxes during shift counts, flushing used patches (if state law allows) with a witness to co-sign, and cutting patches into tiny pieces or running them under water before putting them into sharps containers with a witness co-signing.

-Adapted from Briefings on Liability Risk Reduction, published by HCPro, Inc.

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