The hand is quicker than the eye.

  1. Palm an ampule of normal saline in your left hand.
  2. Ask another nurse to check out that amp of Morphine from the drug cupboard for the patient with renal colic.
    Pick a senior nurse if possible. They tend to be a little more lackadaisical with their checking protocols.
  3. Hold the amp of Morphine between your thumb and index finger of your left hand whilst your colleague checks it.
    Crack it open.
  4. Hold the drawing up syringe in your right hand.
  5. Execute a little misdirection by asking your colleague to check the register for a correct date or some such thing.
  6. Draw the saline out of the amp held in your palm.
  7. Now palm the Morphine and throw the saline amp in the bin with a flourish. If you want to be really sneaky you could pre-load a discarded Morphine amp with saline and simply switch them.
  8. Show the loaded syringe to your colleague to confirm the dose.

You get the idea. Solutions, tablets, whatever.  I’m sure that on any given shift any nurse with a little experience and determination could hoodwink most of us more often than not.
It would make an interesting study.

A long time ago we had a nurse who was using a very fine needle to withdraw pethidine from the plastic amps it used to come in, and replacing it with the anti-histamine Promethazine Hydrochloride (Phenergan).
Once accomplished, it was not obvious that the amp had been tampered with.   The idea was that the patient would become drowsy from the Phenergan and every one would assume it was the action of the Pethadine.
This particular nurse was very senior, and had earnt the trust of many of her workmates.  Which, as it turns out, made it all the more easier for her to help herself to quite a supply of drugs.
In the messy wash up, every nurse who she fooled had to explain why they had signed off that the correct drug had been given to the correct patient.

Nurses at risk.

As most of us are well aware, nursing can be an extremely stressful profession and each of us will out of necessity develop our own coping strategies whether they be nurturing or destructive.
A not so small percentage may slip into reliance on alcohol, prescription drugs or illegal drugs to help manage stress, to bolster self-esteem, or to escape or numb emotional pain.
Nurses spend their working lives immersed in drugs, and we think we know how to manage them pretty well… it can be tempting to indulge in a little self medication to get through an isolated stressful event. For some, this isolated event will slip (behind the glare of self-denial)  into more regular use, compulsive use and eventually a become a full blown addiction.

Not every nurse who is under stress is going to end up with a substance addiction (unless that substance be chocolate). But we should all be aware that it can easily happen. No matter how experienced or respected the nurse may be.
In order to protect our patients and provide early support and assisted recovery for our staff, we must be vigilant and proactive. Despite the stigma of narcotic dependance being an on-the-spot sackable offense, most hospitals recognise the realities of this problem and will have policies in place to provide professional assistance to the person in question.

Hints that a nurse may be stealing drugs:

  • Emerging discrepancies between documented medication administration and the expected pain relief in the patient (increased patient reports of unrelieved pain)
  • Evidence of tampering with vials or drug containers.
  • Fictional patient names being used in the register.
  • Abnormal behaviour, personality changes or swings in mood and levels of performance.
  • Volunteering to administer narcotics or work with patients requiring large amounts of pain medications.
  • Consistently volunteering to be the medication nurse.
  • Large amount of PRN medications being administered.
  • Defensiveness when questioned about medication errors.
  • An increased pattern of medication discrepancies during specific shifts. Increased incidence of documented medication spills , discarded medications or incorrect counts at the end of the shift.
  • Medication dispensed from the drug cupboard without evidence of checking or a second signature in the register.
  • Attempts to remain at the drug cupboard or delay the preparation of drugs during checking.
    I can see you are really busy….I’ll be fine to finish off drawing this up.
  • Increasing social isolation.

What to do if you suspect a colleague is stealing drugs.

If you have any concerns regarding the ‘diversion‘ of medications, you should document them at the earliest possible time.
Documentation should be accurate, objective, and limited to the specific events of the incident including times and dates.

You should next notify an appropriate supervisor or unit manager. Do not try to sort it all out yourself.
Do not beat yourself over the head worrying that you might be wrong. Do not discuss it with other staff members.

This is a delicate matter that needs to be handled correctly in order to provide the best chance of helping someone who may be in very great need.

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