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Diversion of Controlled Substance: Crossing the Line

Diversion of Controlled Substance: Crossing the Line. Kimberly Miller December 5, 2008. Diversion: Issues to Consider. Addiction is a deadly disease Impairment while on the job puts everyone at risk Patient’s pain may be undertreated Patient Care Record may contain false information $$.

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Diversion of Controlled Substance: Crossing the Line

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  1. Diversion of ControlledSubstance:Crossing the Line Kimberly Miller December 5, 2008

  2. Diversion: Issues to Consider • Addiction is a deadly disease • Impairment while on the job puts everyone at risk • Patient’s pain may be undertreated • Patient Care Record may contain false information • $$

  3. What do we know about diversion? • Hard to identify • Risky behavior • It persists even with better safeguards in place • It may be overlooked by co-workers • When is the nurse impaired?

  4. Search Strategies • Keywords • Diversion, theft, controlled substances, narcotics, drugs, addiction, substance dependence, nurse, healthcare provider • Databases • MEDLINE, CINAHL, PsychINFO, Google Scholar • Scope • Inclusion: English language, nurses, research, drug use, diversion, deviant behavior • Exclusion: editorials, legal briefs, opinion papers

  5. Comparison of Drugs Used by Nursing SpecialtyTrinkoff, A., et al. (1998)

  6. Impact of Job Issues on Substance Use in NursesTrinkoff, et al. (2000) • Factors associated with depression symptoms • Job demands • Reciprocal relationship – depression and use • Indirect pathway to increased use – job demands • Factors with direct effect on past year use • Increased workplace access to substances • Less religiosity • More substance users in social network

  7. Effect on Behavior of Nurses Related to Work Group NormsDabney, D. (1995)

  8. Finding Drug Diversion in Operating RoomsEpstein, et al. (2007) • High use of opiates for a case • High wastage of controlled substances • Drugs signed out for cancelled cases • Sign out of drugs late in the day • Location of access to the drug doesn’t match with the location of the patient

  9. Comparison of Nurses in an Alternative to Discipline Program (New Mexico)Dabro, N. (2005) • Nurses who completed the program • Dual diagnosed with MH or Pain • Typically work in ICU/OR/ER/Oncology • Seven of the eight diverted • Strong desire to keep nursing license • Positive response to coercion to obtain treatment • Values participation in support groups • Strong affiliation with other nurses with addiction • Nurses who did not complete the program • Dual diagnosed with MH or Pain • Typically work in ICU/OR/ER/Oncology • Five of the eight diverted • Planning to change careers • Values participation in support groups • Saw no value in monitoring

  10. Alternative to Discipline Program (Idaho)Referral ReasonsClark, et al. (2006)

  11. Ethical Considerations • Harm to Patients • Violation of ethics codes • Multiple levels of deception • Negative effect on other healthcare providers • Moral distress versus illness related behavior

  12. Gaps in Research/Literature • Most studies on factors date to the 1980s • Very little information specific to nurses • Very limited information specific to diversion • No information related to the impact of diversion on patients • Just beginning to see review of effectiveness of alternative monitoring programs

  13. Suggestions?

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