Refractory Pain in the Institutional Setting: Could Diversion be a Culprit?

Drug diversion is universal among institutions in the United States, and is a primary reason for discipline of nurses across the country. Drug diversion is a serious crime that can often result in patient endangerment and abuse. When patient care is entrusted to an impaired provider, the patient may fall victim to negligent care. A patient may languish in pain when a diverting provider steals pain medication intended for the patient or substitutes saline for injectable controlled substances. Nurses who divert risk their professional credentials, job, family, and even their personal freedom. Having a robust diversion surveillance and investigation process is vital for protecting patients from the potentially disastrous consequences of diversion. Prompt recognition of diversion allows for early intervention with the professional involved. Common methods of drug diversion will be explored, and reporting requirements will be detailed. Actual cases of nursing diversion will be presented including cases of patient harm due to substitution or tampering. Proactive measures to prevent diversion will be covered.

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