INVESTIGATION – Diverting controlled substances

You are contacted to investigate the suspicion that a nurse is diverting controlled substances. The suspicious behavior was reported by two coworkers who consistently work with “Nurse A”. Their suspicions are based on the fact that “Nurse A” seems to be accessing the ADC an excessive amount and removing controlled substances compared to the rest of the nurses. “Nurse A” also seldom asks for a witness to waste controlled substances (per protocol, all controlled substance waste must be witnessed in the ADC with another nurse, which generates an electronic record of the waste transaction). You have access to run reports at the ADC level and on the EMR. Why is the ADC and the EMR interface so important in this situation to assist with investigating the waste concern brought up by “Nurse A’s” coworkers? Think about usage patterns of controlled substances on “Nurse A’s” patient care unit. What information would you want in a report to compare “Nurse A” to all other nursing personnel that work on the patient care unit? Another piece of the investigation involves ensuring the controlled substance counts and handling are correct from the point at which the nurse initially access’ the controlled substances in the ADC. How will closed loop automation assist you in tracking the chain of custody of controlled substances from the point it leaves the pharmacy to the point it reaches the patient care unit? Describe any additional information that you think would be helpful to investigate a suspected diversion issue.