§483.12 “Each resident has the right to be free from abuse, neglect, misappropriation of resident property and exploitation… [Another example of] misappropriation of resident property is the diversion of a resident’s medication(s), including, but not limited to, controlled substances for staff use or personal gain.”

Opioid Stewardship Implication: Drug diversion constitutes misappropriation of resident property. As controlled substances, opioids are particularly prone to be targeted for diversion, and facilities retain responsibility to safeguard opioids as the property of residents for whom they are prescribed.

Headline:

“Nurse allegedly stole nursing home patients’ morphine, replaced it with colored water”. A nurse from Lexington is facing numerous criminal charges after being accused of taking morphine from a Lawrenceburg nursing home and replacing it with a mixture of water and blue food coloring. Sadly, this nurse had a backpack with several syringes filled with blue liquid and one used syringe. When questioned by the police department her response was that she wanted to kill herself. She is now facing 21 counts of first-degree wanton endangerment, because police say she was under the influence of the controlled substances while caring for 21 patients “which creates a substantial danger of death or serious physical injury” the warrant states.

Was this nurse a good nurse at some point or did she have a history and we didn’t check? Whatever the answer is, it is Monday morning quarterbacking. What is important is that all 21 residents were safe and unharmed. The bigger issue:

• Do you have policies for chain-of-custody of controlled substances or does the pharmacy drop them on the nurse’s station and leave without counting/signing?
• Are narcotics logs kept current, documentation per policy at off going and oncoming shifts?
• Do you have pre-employment procedures to minimize the risk of drug diversion (F606)?
• Do you respond timely to alleged violations of misappropriation of resident property and/or exploitation (F609, F610)
• Is your medication storage area secure and do policies assist in decreasing opportunities for theft or diversion?

Remember, there are resources to assist you, you don’t have to walk alone! Reach out to your pharmacy provider, your medical director, QAPI committee and/or your HealthCap Risk Manager. Stay well and stay informed.