Re:Topic 2 DQ 1
The issue/problem I chose for my practicum is medication diversion. My organization is not alone in facing the problem. Medication diversion is a widespread problem and, unfortunately, not rare. I live in Ohio, where there is an opioid epidemic that is worse than in many other states. Medication diversion by professionals who are failing to meet standards of care, contribute further to the epidemic. Just recently, 3 young men were arrested in Franklin County in Ohio for possession of 4.5 pounds of fentanyl. Those young men had to get that Fentanyl from somewhere, likely a professional that had access to it.
Nurses have a responsibility to maintain professionalism and prudent standards of care, and to do no harm. Diversion causes “harm to the drug diverter and others…patients, co-workers, and employers” (Berge, et al., 2012, pg. 674). Diversion is not only illegal and dangerous, but it is unethical. We must do something to keep our patients safe and protect them from preventable harm.
One nursing implication is patient harm. When a patient is cared for by a nurse that is diverting, he/she experiences uncontrolled pain due to receiving a smaller dose of medication, or none at all. The Mayo Clinic (Berge et al., 2012) provides a vignette about a nurse in a procedural arena that had a pouch sewn into her scrubs where she would deposit vials of Fentanyl that she had obtained for the patient. She then administered saline to the patients instead. Other risks to patients include infection, and even death.
Another nursing implication of diversion is possible harm to other nurses. If a diverting nurse asks another nurse to waste a narcotic, but the medication vial has saline instead of medication, the witnessing nurse can be held responsible. It is of utmost importance to witness waste as it is pulled from the pyxis, not after. Additionally, if a patient experiences a negative outcome, other nurses that cared for the patient can be questioned and have legal consequences. If the diverting nurse administers something other than the medication ordered, he/she is obviously not going to pass that off in hand-off. If the patient subsequently expires, that could very possibly come down on the nurse that took over patient care from the diverting nurse. Other nurses are also at risk for injury as a result of working with a nurse that is altered (if he/she is diverting medication for personal use).
Berge, K., Dillon, K., Sikkink, K., Taylor, T., & W. Lanier (2012). Diversion of drugs within health care facilities, a multiple-victim crime: Patterns of diversion, scope, consequences, detection, and prevention. The Mayo Clinic Proceedings, 87(7):674-682.
NBC 4 Staff (2017). Prosecutor: Three men arrested had enough fentanyl to kill everyone in Columbus. NBC 4. Retrieved from http://nbc4i.com/2017/11/03/prosecutor-three-men-arrested-had-enough-fentanyl-to-kill-everyone-in-columbus/.