By JoAnne Myhre, CPhT, BA, and Ann Byre, PharmD, of Allina Health
This is the fourth in a series of posts about drug diversion.
Drug diversion can take on many different forms and faces, so it can be difficult to detect. While appearance may not always clue you in to a diverter, there are some common behaviors and characteristics to be aware of.
Common Reasons for Diversion
It’s important to remember that most healthcare providers who divert are not necessarily bad people; they most likely went into healthcare for the right reasons and turned to diversion as the result of a personal struggle or recent trauma.
Because of the physical and emotional nature of healthcare jobs, drug abuse is an occupational hazard. Many doctors, nurses and other healthcare providers experience compassion fatigue and burnout from constantly suppressing their emotions while at work. Shifts can be long and physically demanding, compounding existing exhaustion and stress.
Some staff may have personal injuries and chronic pain of their own to deal with and may have received a legitimate prescription at one time and then became addicted. The biggest overall factor that contributes to drug abuse by healthcare workers is access to and availability of controlled substances.
Profile of a Diverter
A typical diverter is often the last person you would ever suspect. They tend to be high achievers, extremely bright, well-liked and involved in their profession – these are usually regarded as positive traits. Healthcare workers generally divert for personal use, and they are extremely secretive about it. Some common characteristics and behaviors of the typical diverter include:
- Very persuasive
- Quick to provide explanations—able to come up with clever and elaborate schemes
- Chaotic home/personal life
- Has or had a legitimate prescription for the drug that is being diverted
- Works in an area where nursing staff often has increased autonomy
- Volunteers to pick up extra shifts or is always in early or staying late
- May have various practice issues like: charting errors, increased usage of controlled substances vs. peers, frequently spills/wastes controlled substances, excessive use of automated dispensing cabinet override feature to remove controlled substances
While the behaviors of a diverter certainly contribute to the occurrence of drug diversion in hospitals, there are other aspects that play a part as well. For instance, the healthcare facility environment is often a part of the problem. Drug diversion may be more prone to happen if a workplace exhibits the following factors:
- Lax environment—the manager ignores irregularities such as improper patient medication processes
- Manager who is a former colleague of subordinates or is unable to be authoritative
- Manager who is overextended and therefore distracted
- Low morale of the staff
- High turnover or poor training of staff
- Lack of visible and/or perceived controls, i.e. camera technology, site awareness of drug diversion
Warning Signs of Diversion
While there is no way to prevent drug diversion entirely, there are certain warning signs to look out for. A healthcare worker who frequently disappears to the bathroom or utility room for long periods of time, or one who is overly helpful, arriving early and staying late, are both signs of a potential diverter. Other red flags include:
- Coming to work when not scheduled
- Dispensing medication near or at end of shift
- Medicating patients not under their care or for patients even after they are discharged
- Ignoring patient medication management guidelines
- Either no or heavy wasting of drugs
- Holding waste until oncoming shift
If the diversion scheme is not detected in the early stages, a diverter may exhibit these more extreme behaviors, some of which are counter to the profile traits listed earlier:
- Unpredictable work performance, recurrent mistakes, poor judgment and bad decisions
- Poor interpersonal relations
- Attitude and demeanor that becomes volatile, or isolated and sullen
- Blames environment and others for errors
- Frequently arrives to work late or does not show up at all
- Frequent, unexplained disappearances during shifts
Knowing common characteristics and behaviors associated with diversion is important for detecting it early—ideally before patients are put at risk.
JoAnne Myhre, CPhT, BA, is the Drug Diversion Program Manager for Pharmacy/Compliance Services at Allina Health, and Ann Byre, PharmD, is the Director of Pharmacy Services at Allina Health. As health system level leaders, JoAnne and Ann collaborate and help lead both proactive and reactive components of the Allina Health Drug Diversion program.
Continuing the Diversion Discussion
The next post on drug diversion will discuss how to spot drug diversion in your facility, and future posts will cover how to respond to diversion incidents.
View the previous post on diversion here.