I frequently have nurses who call stating that they are in trouble due to an alleged diversion claim, which they did not do.  They simply made a documentation error.  Diversion is defined as “turning something aside from its course.”  Diversion can mean giving one patient’s drug to another patient, taking the drug for yourself or taking the drug for another person, i.e. selling the drug.  Automatic dispensing systems like the Pyxis and Omnicell make it easy for hospitals to track everything you do.  Here are situations that I see that raise red flags.

The first is with regard to wasting medications.  If you need to waste medication, a coworker must cosign the waste.  If there is no co signature, that raises a red flag.  Remember, if it wasn’t documented, it wasn’t done.  Make sure your coworker actually watches you waste rather than simply signing the form or inputting it into the Pyxis.  If a patient only needs 1mg and you take out 2mg and a 1mg vial is available, that is also a red flag or if you accidently pull the wrong med.  If there is a long delay in getting medication wasted, that raises a red flag.  Narcotics should not be carried in your pocket for a long period of time.  It provides time for someone to tamper with the medication.  I know sometimes it can be hard to find someone to cosign the waste and the Pyxis can be a long way from your patients, but protect yourself and waste right away.

Nurses like to be proactive and sometimes take meds out early that they know they are going to give.  While it is great to be prepared, taking medication out of the Pyxis too early is another red flag.  Again, keeping narcotics in your pocket is improper except to bring it directly to the patient.  When there is a delay in documenting the medication in the MAR, that’s also a red flag or worse, not documenting it all.  Make sure if your facility uses scanners that you hear the beep and that you confirm that medication given was documented on the MAR.   This is your license and your livelihood, so don’t cut corners.  Do it right.

Lastly, many automatic dispensing systems like the Pyxis and Omnicell have software in them that can track how many controlled substances you give compared to your coworkers.  If your administration is higher, you will be under closer scrutiny.  This does not mean not to give the meds to your patients in need, but to make sure that you and your coworkers have the same philosophy about medication administration so you don’t look like the outlier.  Administration of controlled substances is a very serious responsibility.  Care in dispensing, administering and documenting controlled substances is the outmost importance.  You do not want to be in a position where you are accused of diversion as documentation issues can be avoided.