Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA

I hear that many long-term care nurses are addicted to drugs and alcohol. Is there a way to be proactive for the safety of my residents and other staff members?

The entire facility must be responsible for diversion prevention. Every nurse handling medications must be proactive and know the seriousness of drug diversion. 

Consequences can be high: scope and severity for citations, impaired nurses taking care of our residents, legal and ethical concerns, and lower quality of care for the residents. They certainly did not sign up to be cared for by a nurse with a problem in drug diversion. If nurses are using one particular resident’s pain medications, that poor resident suffers even more.

The National Council of State Boards of Nursing published a book in 2011, “Substance Use Disorder in Nursing,” which helps with developing policies.

Remember: Nurses who divert are good at what they do. Everyone needs to be on their toes and not just think that simply counting narcotics at the beginning and end of the shift will find everything — it won’t!

Every nurse needs to know the type of medications, signs of diversion, signs of an impaired nurse, and ways to observe nurses passing medications that may not be appropriate. 

Don’t get into a routine of accepting blanks on the MAR, or nurses not counting narcotics. Be sure all of the narcotics for a resident no longer in the facility do not linger on the floor. Be sure to follow facility policy, and if the narcotics need to be taken to the DON’s office, see that they get there.

Don’t use the same people for drug destruction all the time. Have the administrator or executive director step in from time to time. The pharmacy and pharmacy consultant also can help with developing policies.