The legal issue at hand in the current case scenario relates to the diversion of drugs, which is defined as “the unlawful channeling of regulated pharmaceuticals, including the misuse of prescription medications” (Tanga, 2011, p. 14). If a nursing professional is reported to be chemically impaired and is suspected to be taking drugs from a hospital, an investigation must occur immediately to identify any system failures and remove them accordingly. The purpose of the current paper is to analyze the case of nurse misconduct associated with drug diversion and identify relevant investigation and improvement strategies targeted at avoiding the problem in the future.
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Investigation of Diversion
According to the report by Centers for Medicare and Medicaid Serveces (2012), drugs that are the most commonly diverted include opioid-based pain relievers due to the state of euphoria that they usually induce. To investigate the allegation of a healthcare provider’s drug diversion, several steps should be taken. First, the nurse under question should pass a background check for reviewing any criminal, licensure, and regulatory issues that may have occurred in the past.
The check can also include the analysis of any accountability and discipline violations. Second, all withdrawals from drug stores that have not been verified by a physician should be reviewed. Third, the physician’s record-keeping procedures should be assessed for determining whether there have been any errors as well as deliberate records of controlled substances. Fourth, a random drug test should be conducted for determining whether the nurse in question is under the influence of any detectable substances.
If it is revealed that a nurse has been diverting drugs from a healthcare facility for personal gain, administrative action, civil prosecution, or civil penalties and fines can be implemented. The choice of either strategy will usually depend on the severity of diversion as well as on the financial and reputational impact that a facility had to manage afterward. If the case of drug diversion occurred for the first time and the nurse under question does not have any record of prior misconduct, both fines and the registration of the incident can be sufficient. If, on the other hand, the nurse was previously involved in similar offenses, the legal prosecution can be chosen as the solution (Berge, Dillon, Sikkink, Taylor, & Lanier, 2012).
Recovery Strategies for Nurses
Usually, each state has a board that guides the professional practice and therefore provides nurses with resources and programs for addressing complex issues such as substance use. Such programs should involve several steps for guaranteeing nurses’ recovery. An effective method to propose as a strategy for a recovery program is peer assistance, which implies the support provided by other nurses in assisting those with substance abuse problems overcome their condition. A peer assistance program will include comprehensive analysis, case management, and monitoring, relevant education necessary for recovering from abuse, the provision of community resources (e.g., group counseling sessions), hotline services, and the support for a recovering nurse’s family.
Before identifying strategies targeted at the improvement of quality and reduction of costs associated with drug diversion by nurses, it is important to clarify that such misconduct can pose a significant threat not only to the reputation of a facility but also to patient safety. Because of this, identifying effective prevention and management strategies is an essential step in ensuring that the adverse effects of drug diversion do not influence organizational credibility.
As mentioned by Umhoefer and Finnefrock (2016) for their Hospitals & Health Networks article, several strategies should be implemented for establishing controlled substance prevention. The first strategy is updating available procedures and policies through identifying existing gaps in practice. The second strategy is creating strict rules and standards that regulate the prescription of controlled drugs (Umhoefer & Finnefrock, 2016). The third strategy that can be especially relevant in improving the quality and reducing costs is establishing relevant training and education efforts for informing nurses on how to act in cases of controlled drug diversion.
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Specific implementation strategies include placing surveillance in areas where controlled substances are stored and having a specific action plan ready for implementation in cases when diversion is noticed (Substance Abuse and Mental Health Services Administration, 2016). Additionally, healthcare facilities can integrate peer support programs for helping nurses overcome their addiction in cases when drug diversion has been linked to substance abuse.
Drug diversion by nurses is a serious safety and reputational issue that all healthcare facilities want to avoid. Nurses may engage in this unlawful act in cases of drug addiction or for personal gain of selling controlled substances to patients that do not have a prescription for them. Effective strategies for diversion identification include surveillance, random drug tests, and reviews of record keeping. Depending on the severity of the violation, a nurse may be subjected to punishments ranging from fines to criminal prosecution. To prevent the issue from occurring in the future, healthcare facilities are recommended to invest in education and training as well as integrate peer support programs for nurses dealing with addiction.
Berge, K. H., Dillon, K. R., Sikkink, K. M., Taylor, T. K., & Lanier, W. L. (2012). Diversion of drugs within health care facilities, a multiple-victim crime: Patterns of diversion, scope, consequences, detection, and prevention. Mayo Clinic Proceedings, 87(7), 674-682.
Centers for Medicare and Medicaid Services. (2012). Drug Diversion in the Medicaid Program state strategies for reducing prescription drug diversion in Medicaid. Web.
Substance Abuse and Mental Health Services Administration. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: US Department of Health and Human Services.
Tanga, H. (2011). Nurse drug diversion and nursing leaders’ responsibilities: Legal, regulatory, ethical, humanistic, and practical considerations. JONA’s Healthcare Law, Ethics, and Regulation, 13(1), 13-16.
Umhoefer, S., & Finnefrock, M. (2016). 6 steps for hospitals to take to prevent prescription drug abuse, diversion. Hospitals & Health Networks. Web.