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Old 09-08-2008, 11:36 PM
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Default "Red Flags" of drug diversion

1. Volunteers, frequently, to work overtime, extra days.
2. Uniform consists of a lab coat with pockets or clothing that is loose fitting.
3. Often "disappears" from the unit aside from expected "break times" (meals, etc.)
4. "Nods off" at the desk, or frequently c/o "feeling so tired" lately.
5. Mood changes from quiet and subdued, to suddenly being animated, charming, engaging and confident.
6. Avoids being in the Med Room when others are there, and is observed being alone much of the time (in the Med Room).
7. When alone in the Med Room, and others enter, makes a hastey exit.
8. Often "forgets" to sign out scheduled drugs until the end of the shift.
9. Volunteers to be the one to "make out new narcotic sheets" for oncoming shift.
10. Volunteers to be the one doing the Narcotic Sheet count, as opposed to the cupboard's Narcotic Stock supply at change of shift.
11. Volunteers to give your "prns" for you.
12. Volunteers to go to Nurse's Lounge and make the whenever needed.
13. Has a locker assigned, but rarely uses it.
14. Often has "bruises" on top of hands, and covers them with a bandaid.
15. Appearance of bloodstain (fresh) on uniform pants in thigh area.
16. Her patients who are in pain "never seem to obtain effective relief", or are "still agitated, uncomfortable and anxious" when she claims she has "just medicated" them.
17. Shops for orders for her patients relative to pain medication. i.e., "Dr. So-and-so....the Vicodin is not working for Mr/Ms "X", could we give something stronger" - when the Vicodin had been working all along.
18. Charting reflects having "given" a narcotic injection to a patient on the day of discharge.
19. Writes a T.O. order for narcotics, but never called a doctor.
20. Volunteers to be assigned the sickest patient or patients. (who have narcotic orders in abundance)
21. Frequently leaves out details required on Narcotic Sheets.
22. Is often late to work.
23. Calls in sick more than usual.
24. Ignores, even "jokes" about the necessity of and seriousness of policy and procedure surrounding narcotic dispension and documentation.
25. Pockets multi-dose vials of normal saline (10cc and 30cc).
26. Has a "ready supply" of syringes and needles in her uniform pockets.
27. Is known to never "empty" out pockets of such supplies at end of shift and before leaving the hospital.
28. Gives conflicting information about her patient's degree of pain to oncoming shift. (on "her" shift, the patient was in "great" pain and "needed" medicating either more often, or with larger doses)
29. "Forgets" to tell oncoming shift she "just" medicated patient with a narcotic, and conveniently "forgets" to chart same on med sheet.
30. Is known to "save" partial doses of narcotics (not used), because...."patient might need it later."
31. "Wastes" narcotics without a second witness, and asks you to "please sign" at end of shift - "I was in too much of a hurry and no one was around then."
32. Distances self from management, administration, and others in charge.
33. Rarely asks "for help" from peers with regard to patient cares requiring such help. (prefers to "work alone")

What I've noticed most often is they are more than willing to give my PRN's. They keep vials of NS in their pockets and their patients have always requested 2 pain pills but when I have the patient on the following shift they only ask for 1 pain pill.
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Old 09-08-2008, 11:43 PM
HhRNhhr
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The only one that fit me was feeling tired all the time.

I am not being blind nor am I in denial. No kidding, the part about being tired is the only one that fit me.
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Old 09-09-2008, 01:06 AM
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Quote:
Originally Posted by HhRNhhr View Post
The only one that fit me was feeling tired all the time.

I am not being blind nor am I in denial. No kidding, the part about being tired is the only one that fit me.
Hey Taz - Reading DG's list, I think most of them, or at least 1/2 of them applied to me. Thank God, I had my 9 year anniversary last month. Actually the hubbie and I both have 9 years last month.

Anne :th_::th_::th_:

Last edited by ilovemypuppies; 09-09-2008 at 01:07 AM. Reason: sp
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Old 09-09-2008, 03:03 AM
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Except for the bloodstains and bruising, that could be me...not narcs though. I divert an MVT or if I'm in a PMS bloat I'll cop a lasix but dang I can't imagine diverting narcs. I don't think I would want the nurse to get into huge trouble over it but would like to see that they got some help for the problem if they wanted it.
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Old 09-09-2008, 04:41 AM
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where did the list come from?

When you sign out narcs there, you do have two ppl?
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Old 09-09-2008, 06:09 AM
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Quote:
Originally Posted by nyapa View Post
where did the list come from?

When you sign out narcs there, you do have two ppl?

No, we only have two people to waste and to count at shift change. The oncoming nurse counts the stock and the offgoing makes sure the numbers match.

Haven't had a diverter at our place for several years (like 10)
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Old 09-09-2008, 06:22 AM
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Oh, ok. Here we have to have two ppl sign out each narc and some drugs of dependence and accompany each other to the bedside.
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Old 09-09-2008, 07:49 AM
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Wow, we'd never have the time to do that Nyapa, but I do think it's a good idea.


Tazzi and Anne. Congratulations on your recovery

The list came from a nurse manager at the hospital.

I likewise don't think I could divert narcs but I never say never, "but for the Grace of God go I". I admire those who can admit, go for treatment, remain clean and are able to share their stories with others.

I don't mind sharing my experience with major depression. I believe in passing it on.
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Old 09-09-2008, 08:01 AM
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Not saying at all that the list is wrong, it's very correct. Just saying that I was not the norm and to not expect that all diverters fit that list.
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Old 09-09-2008, 08:21 AM
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You are right about the time issue, just another thing to keep us away from our patients. 'Who's got the keys, can you check with me?' Can take up to 20min once you have found the person, then if they are willing, you have to then write the book and the chart up, and finally give it to your patient with the other person in attendance.

I think it is a really good safety check issue though...
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