Ask the care expert .. about drug diversion

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

Is there a list I can give staff on preventing diversion of drugs?

Early identification of diversion and abuse benefits everyone involved. However, don't jump to conclusions before you are sure of the actions that are making you uncomfortable. 

Red-flag staff behavioral indicators

• Isolates self from others, eats meals alone, avoids staff social events

• Frequent, unexplained disappearances during shift

• Often shows up on days off to finish work or retrieve forgotten items

• Frequently late to work

• Frequently volunteers to work extra shifts

• Volunteers to hold the narcotic keys/perform count

• Frequently spills or wastes narcotics

• Chaotic home/personal life

• Frequent confrontations with other staff members

(List used with permission from
Remedi Pharmacy/

Best practices against diversion

• Remove medications only for your assigned patients

• Remove only current dose of medication for your patient

• Properly document medication administration and pain scores

• All wastes of medications must have a documented witness

• Don't be a “virtual witness” to medication wasting or shift-to-shift narcotic count

• Don't loan your ID badge or pass-codes

• Return unused medications according to procedure

• Report medication discrepancies promptly to administration

• Report attempted inappropriate access to medications

• Report witnessed or suspected medication diversion


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