The most popu-
lar technique for
diverting drugs is
substitution.
Instead of admin-
istering fentanyl, a
provider may
replace it or cut it
with saline or ster-
ile water.
Improper charting
and withdrawing
of meds are also
popular ploys, as
is outright theft.
Opioids
(painkillers, keta-
mine, propofol
and inhalation
agents) and ben-
zodiazepines are
the most com-
monly diverted
drugs, according
to CMS. Anything
that's not in a blis-
ter pack is an easy
mark. It's easy to
replace a few
Anesthesia Alert
AA
3 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 7
Detecting Diverters: Signs Are Plentiful
It's easy to spot the signs when a surgical team member is diverting
drugs — if, that is, you know where to look. This table outlines the
signs and actions of a diverter.
Behavioral Signs Physical Signs Actions
Excessive and/or
unexpected
absenteeism
Changes in appear-
ance and hygiene
Heavy wastage
of drugs
Frequent and
sometimes long
breaks
Shakes
(until they can get
more meds on board)
Drug shortages, slop-
py records or suspect
opioid removals
Excessive time
spent in the
medication room
Coincidental alcohol on
breath (alcohol is often
used as a "bridge"
until more drug can be
diverted)
Discrepancies
between recorded
medication adminis-
tration and expected
patient response
Performance
issues, mistakes,
poor judgment
and bad decisions
"Blood dots" on scrubs
from injection sites
(yes, some desperate
addicts will inject
directly through scrubs)
Evidence of tampering
with vials or drug con-
tainers, and frequent
controlled substance
ampule breakage
Confusion or diffi-
culty concentrating
or recalling details
and instructions
Chronic count
discrepancies and
failing to obtain
co-signatures
Deteriorating
handwriting and
charting
Offering to set up
rooms for fellow
providers and asking
for their benzodi-
azepines or opioids
Mood swings,
anxiety, depression
and irritability
Patients consistently
waking up in pain
disproportionate to the
amount of opioid used
and using inappropriate
amounts for procedures
Unwillingness to
admit or take
responsibility for
errors
Consistently signing
out more opioids than
other anesthesia
providers
Attitude that gener-
ates complaints from
patients and staff
Requests for long
cases (to justify sign-
ing out more opioids)