Substance abuse in healthcare providers

drug diversion, stealing drugs, nurse impairment, doctor impairmentA previous post written by a nurse/patient disclosed a suspicion that the nurses in the emergency department took the medications that were charted as given to the patient. Substance abuse among healthcare workers is an often unrecognized problem. The healthcare provider who diverts (steals) drugs to inject, swallow, inhale or sell may do so for long periods without being caught.

There are often clues to substance abusing healthcare providers. They may

  • Tell their coworkers about pressing family problems
  • Select the night shift to work where there are fewer people watching them
  • Be increasingly irritable and angry
  • Miss time from work because of the effects of abusing substances
  • Drink more heavily at social gatherings
  • Have legal problems from DUIs, public drunkeness

Drug Diversion in the 1960s and 1970s
In the 1960s and 1970s, it used to be fairly easy to divert drugs from a hospital. Sedatives, hypnotics, and narcotics came in multidose containers and were not counted. That changed when drugs were labeled as scheduled drugs based on their habit forming and potential for abuse characteristics. There are now various safeguards built into the medication administration system to prevent diversion of drugs. Now every dose of these medication is counted or accounted for. In nursing units without drug dispensing carts, two nurses count the drugs by hand at the end of each shift. Drug dispensing machines eliminate the need for counting. If a nurse needs only 1 cc of a narcotic that is dispensed in a 2 cc container, the nurse is supposed to find someone to witness the wasting of the other cc. Narcotics are packaged in tamper-proof containers that would prevent someone from removing the active drug, substituting in another fluid, and resealing the package.

Techniques of Drug Diversion
Healthcare providers can still steal or divert medications. They may give the patient only half of the ordered drug and keep the other half for themselves. They may give the patient saline (salt water) and keep all of the dose of the medication for themselves. Patients frequently notice this and may complain to other staff that when a certain nurse is taking care of them, they do not get the pain relief they expected and need.

The nurse who wrote the previous post saw her medication administration record and knew she had not received all of the medications that were listed. Each dose of a medication has to be ordered by a physician, physicians assistant or nurse practitioner. The medication administration record documents the name, dose, time and provider who gave the drug. In the event that the record was reviewed, the absence of orders for all of these medications would have been glaring.

Impaired Healthcare Professionals

Some healthcare providers carry their habit into the workplace and take the drugs while on duty. Their behavior shows signs of impairment of the ability to function. This is a highly dangerous situation. Health care requires all of one’s abilities to function in a highly technical, fast paced environment. See this post about the effects of sleep deprivation and how it causes impairment of surgeons. The impaired nurse or doctor may disappear from the work area (while taking the drugs), slur speech, be uncoordinated and not think clearly. Or the individual may act manic, high, be giggly, or talk rapidly.

What You Can Do

  • Tell a person in a management position (head nurse, charge nurse) if you feel you are not getting adequate pain relief.
  • Tell a person in authority if you observe a healthcare provider injecting himself or herself.
  • Tell a person in authority if your provider smells of alcohol or is behaving in an unusual way.
  • Speak up. Your life could depend on it.
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