Drug diversion in nursing is a major nursing board complaint. A nurse accused of diverting meds needs a lawyer. Take a look at the 2024 fiscal year report of the Missouri Board of Nursing. The highest percent of complaint categories was “Criminal” at 32%. Just behind, coming in at #2 is “Alcohol/drugs” at 31%. In 2024, the Missouri Board of Nursing closed 1306 complaints. That means the Board investigated 404 alcohol/drugs complaints that were not criminal. The report does not break down the number of complaints for medication diversion, but I’ll bet its the vast majority of complaints. That means the Board heard hundreds of nurses explaining their workplace practices. And don’t forget, that is just for one year. THE BOARD HAS HEARD ALL THE EXPLANATIONS used to justify violations of the Missouri Nursing Practice Act. This is why nurses are caught–there just aren’t that many new ways to hide it. The Board, and your employer, have seen it all. Here is what I see in my practice, and watching nurse complaint hearings.
Pyxis/Omnicell Reports
Pyxis and Omnicell audits will get you. Your employer will find discrepancies between dispensing, wasting, and charting. The Pyxis has software that will flag an authorized user by comparing each nurse’s med removals. For example, if a nurse administers 7 times the amount of narcotic medication over other nurses on the shift, its flagged. Pharmacist testimony on audits are difficult to beat. Don’t forget, the nurse has also scanned a fingerprint or patient card into the machine, so its tough to blame someone else for a med error.
How are you going to convince the Board the head pharmacist is wrong? Possibly, compare the pyxis report to those in Epic. However, we don’t always get access to Epic when defending a complaint.
Pain Scale Discrepancies
Some nurses try and justify excessive narcotic pulls by charting the patient’s pain level much higher than other primary nurses on the same patient. You’ll get caught if you chart the pain as a 7, when the shifts before and after chart the pain as zero.
You might be caught diverting if you…
- Have excessive overrides;
- Access pyxis in another unit;
- Access meds when clocked out;
- Administer meds to another nurse’s patient. Even if you claim you’re helping the nurse out.
- Chart a verbal order from an off-duty doctor.
- Entering a verbal order when the physician will not confirm.
- Replace the narcotic with a different pill/vial.
You might be caught diverting if you administer 7 times more PRN meds than your colleagues.
“I care more about my patient’s pain than other nurses.” This will not justify withdrawing 7 times the meds that other primary nurses administer for the same patient. I have seen a chart of “resting comfortably” followed by pain level 10 on the next shift. Also, I’ve seen the nurse chart “resting comfortably” and withdraw the oxy anyway.
You might be caught diverting if you do not
- Chart waste;
- Waste with a witness;
- Chart administration of meds;
- Account for the entire amount of the vial withdrawn. Amount wasted + amount administered doesn’t equal the total vial amount;
You might be caught diverting if you…
- Have a syringe in your locker or,
- Carry empty syringes for hours after administering any IV meds.
- Take long absences from the floor, including the bathroom, your car, or the parking lot;
- Do not answer your phone/pager;
- You appear impaired
Lastly, the Nursing Board has seen it all, and heard explanations. Also true of your DON and employer. Stop diverting meds, get help. Before you’re caught. See my blog on substance abuse complaints for more info.