When a nurse suspects diversion or impairment, patient safety concerns require that it be reported. Good-faith concerns should be communicated to supervisors or diversion specialists. Depending on the situation, regulatory requirements also may include contacting these agencies:. Save my name, email, and website in this browser for the next time I comment.
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Password recovery. Home Clinical Topics Drug diversion in healthcare. Drug diversion in healthcare. May 6, Awareness and recognition are the first steps to prevention. Reduce waste to impede diversion New says that drug diversion most commonly occurs during wasting. Signs of diversion Education about the behavioral and physical signs of drug diversion helps nurses recognize it. Methods for diverting controlled substances include stealing syringes or vials under-dosing patients replacing controlled substances with another product, such as saline taking PRN medications from patients or pulling duplicate doses creating false verbal orders failing to waste or document waste, or raiding sharps containers.
General signs of diversion include patients complaining of unrelieved pain or not receiving medications that have been documented as administered drug-related items found in staff bathrooms or breakrooms controlled medications with broken or unsecured caps or found in cabinets out of exterior packaging.
SEE something, SAY something Identifying signs of drug diversion can be challenging but is a crucial step in reporting and halting drug diversion in healthcare. Reporting requirements Appropriate responses to drug diversion include creating a culture where reporting is encouraged and where prompt reporting to enforcement agencies is routine.
Depending on the situation, regulatory requirements also may include contacting these agencies: law enforcement pharmacy board Food and Drug Administration Office of Criminal Investigations for tampering cases Office of Inspector General. Drug Diversion and Best Prescriptive Practices. Best practices for the safe and cost-effective management of controlled substances. Tags drug diversion Medication wasting Wasting.
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Nosocomial Pseudmonas pickettii bacteremias traced to narcotic tampering: a case for selective drug screening of health care personnel. Hepatitis C outbreak linked to narcotic tampering in an ambulatory surgical center [Abstract]. Serratia marcescens bacteremia traced to an infused narcotic. San Francisco, CA; October 8, Investigation and control of an outbreak of Achromobacter xylosoxidans bacteremia.
Ramer, H. December 22, Outbreak of gram-negative bacteremia at St. Cloud Hospital. Sept 14, June News Release. State health officials provide update in the case of potential hepatitis C exposures at Hays Medical Center external icon. August Walker AK. Baltimore Sun. August 12, To receive email updates about this page, enter your email address: Email Address.
What's this? Links with this icon indicate that you are leaving the CDC website. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. You will be subject to the destination website's privacy policy when you follow the link. In addition to denial of essential drugs to treat patients in pain, outbreaks of hepatitis C virus HCV transmission from an infected healthcare worker to a patient have been reported in the setting of narcotic diversion when tampering with injectable opioids, as well as transmission of bacterial pathogens, with fentanyl being the most commonly implicated opioid.
Drugs stolen from health care facilities are commonly used to support an addiction of the health care worker HCW. This theft can be of unopened vials; vials or syringes that have been tampered with, resulting in either substituted or diluted dosages being administered to the patient; or residual drug left in a syringe or vial after being administered to the patient.
A healthcare worker in Colorado infected with hepatitis C virus HCV infected 18 patients as a result of stealing fentanyl in the operating room intended for patients and injected herself and refilled the same syringes with water or saline. Another HCV-infected traveling radiology technician infected 45 patients in New Hampshire, Kansas and Maryland by stealing syringes with opioids, self-injecting and refilling with saline.
Gram-negative bacteremia developed in 25 surgical patients at a Minnesota hospital that was linked to a nurse tampering with IV bags containing opioids used for patient- controlled analgesia PCA machines — using a syringe to remove opioids and replacing liquid with saline. CDC has investigated these, and many other outbreaks related to drug diversion activities that involved healthcare providers who tampered with injectable drugs.
Schaeffer and Perz CDC has compiled a summary of these outbreaks and timeline. All health care facilities should have systems in place to deter controlled substance diversion to include methods to promptly identify and investigate possible diversion, intervene when it is occurring and follow up to deal with outcomes of confirmed diversion.
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