Some Helpful Tips on Hospital Drug Diversion Investigations

The U.S. Attorney’s office has confirmed that 19 Rose Medical Center patients have tested positive for hepatitis C. Investigators believe the source of those cases may be a surgical scrub technician suspected of injecting herself with Fentanyl meant for patients and filling the used syringes with saline solution for re-use, according to CNN.

On July 23, a federal grand jury indicted 26-year-old Kristen Parker on 42 counts of product tampering and obtaining controlled substances by deceit. More charges may follow and, according to the Denver Post,Parker could spend the rest of her life in prison. As many as 6,000 patients who had surgery at Rose Medical Center and Audubon Surgery Center may have been exposed to the disease.

This case highlights the risks associated with hospital staff diverting drugs. Although the rate of addiction among medical professionals is the same as the general public, hospital officials may struggle to detect when one of its employees is using drugs that should be given to patients.

Chuck Moore, the security director at Northwest Hospital in Randalls Town, Md., has handled many drug diversion investigations in his five years in the position. Two of the more common indications a staff member may be abusing drugs is tardiness and taking more sick time, Moore tells Campus Safetymagazine.

Their on-the-job behavior may also change, he adds.

“Depending on the drug they are diverting, their actions are a little bit slower, and they’ll make more mistakes,” he says.

An employee’s documentation of drugs administered to patients might also be inaccurate. Moore says, “When a nurse gives injections or medications and they don’t use the full amount, they are supposed to waste them in front of a witness. Then that information is placed into the AccuDose computer.” When the tracking is off or when too much of a substance is used, the computer alerts hospital management.

Inappropriate clothing can also be an indication of narcotics abuse. “If they are injecting, you’ll see that they are covering their arms a lot,” he adds. “They’ll wear long sleeves in the summer.”

As the Rose Medical Center and Audubon Surgery Center cases demonstrate, employee screening doesn’t always uncover these issues before a staff member is hired. Parker started working for Rose Medical Center in October 2008 and was fired in April due to testing positive for Fentanyl. She then worked for Audubon Ambulatory Surgery Center in Colorado Springs from May 4 until July 1. A statement released on Audubon’s Web site said the hospital conducts background checks of all of its employees but that Parker’s interview, reference checks and drug tests didn’t reveal anything noteworthy.

Moore says that very often, a nurse who is abusing drugs will be reported to the nursing board, and if his or her license is suspended, a background check will uncover the disciplinary action. “But a lot of times, especially with clinical staff, they’ll go through a treatment program and once they are done, the nursing board will re-evaluate them and may give them their license back, so we may not know.”

Another challenge to the employee screening process comes about when a nurse, technician or doctor moves to a different state, county or city. Drug abuse or other inappropriate behavior may not be uncovered in these instances if the background screening process doesn’t check with all of these entities. And even if the background check is comprehensive, a slow reporting and disciplinary process can impact the screening’s accuracy.

Moore is quick to point out, however, that when hospital employees are first hired, most don’t have any intention of diverting drugs. “Most of the nurses I’ve encountered had injuries or surgeries where they were prescribed medication for pain, and they wind up getting hooked on that medication,” he says. “They start diverting after that.”

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