An increase in potential narcotics diversions were occurring within our Emergency Department after an influx of Agency nurses. What was happening; pain meds were being administered without corresponding orders and single dose vials were being used as multidose vials. We discovered that orders were not being written when crucial conversations took place between practitioner and nurse. Nurses were adminstering meds based on verbal orders, not thinking to follow-up with the physician or even hand the chart to the physician so they could write the order “real time”. I had worked in the ER for many years prior to my current position and there was always a sense of trust between nurse and physician. You helped each other out by doing for the other or even prompting when necessary. I find it rather interesting that there seems to be a new culture within the department that seperates physician and nurse; a form of alientation that fosters distrust. You hear things like: “That’s not my job” by nurses when discussing giving meds without orders, or “I didn’t know he did not write the order” or “I can’t give these meds even though I had a verbal order?” The other issue of using single dose vials as multi-dose vials come from not wanting to waste resources and work-arounds. I can understand the issues presented here. It happens when the physician orders 1mg of Morphine that comes in a 2mg vial. The nurse withdraws the 1mg, administers it, then saves the other 1mg for later, knowing it will be used at some point in time. Unfortunatly, all these actions may and do cause suspicion. Narcotics diversion was becoming such an issue that we ended up contacting an agent from the NYS Health Department, Bureau of Narcotics Enforcement. Imagine my surprise when this gentleman showed up for his in-service sporting a utility belt complete with handcuffs and a lovely government-issue 9mm handgun. Needless to say, his in-service caught the attention of many staff members, not just our ER staff. His presentation was very inciteful, replete with numbers about jail time and fines. Some of the “simple” penalties exceeded $5,000, loss of license, etc. Our numbers regarding narcotics diversion did diminish after his visit, but time will tell if the department goes full circle right back were it started.
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