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In May, 2018 a nurse working at a Wisconsin nursing home was charged with 11 felony and misdemeanor charges.  The charges were: intentionally subjecting an individual at risk to abuse, theft, imitation of a controlled substance, possession of narcotic drugs and obtaining a prescription drug with fraud.

According to the criminal complaint:

A nurse training with the accused nurse witnessed her diverting narcotics.  The nurse trainee said that when he worked with the accused nurse, patients complained of pain even after the nurse gave them their medication.  But when training with other nurses, the trainee said the same residents were not complaining of pain after receiving pain medication. The accused nurse was brought into the DON office and admitted to diverting narcotics but didn’t state the amount of drugs she took or how long she had been doing it.  The accused told the nursing director that she gave the narcotics to her son because he is an addict and becomes violent toward her.

An investigation showed that instead of giving residents scheduled doses of hydrocodone or Percocet, the accused nurse was giving them Tylenol.  The accused nurse was in charge of the narcotics cart, and all medications were signed off and dispensed by her to the nurses for administering to the patients.

The Director of Nursing reported the theft to the local police department.  When the nurse was informed of her firing by a phone call, the DON said her speech was largely unintelligible.  The nursing director reported this to the police who were sent to her home for a welfare check.  It was at this meeting with officers that she admitted her addiction to painkillers.

If convicted of the felony charges, the nurse could be sentenced to up to 16 years in prison.

Facilities are required to implement a system to account for controlled medications receipt and disposal with a record of receipt with details to allow reconciliation.  Records of personnel access, usage and disposition of controlled medications.  Reconciliation for controlled medications should be conducted routinely so that losses or diversions can be detected early.  DON’s should look for patterns to detect drug diversion: same shift, same nurse, same drug of choice.

According to the Federal Requirements if discrepancies are identified the pharmacist and facility must resolve them and make referrals to law enforcement agencies.

In the case reported in Wisconsin, the facility should not have given one nurse total control of narcotics.  Checks and balances and an environment that encourages reporting suspicions is critical in detection of diversion.