Date of Award
Projects: SPU Access Only
Doctor of Nursing Practice (DNP)
Dr. Lorie Wild
Nurse Drug Diversion Prevention: A Pilot Project
Nicole M. Solvang, BSN, RN, CCRN, SPU DNP Student
Background and Significance
Drug diversion is a major rising national problem (Morris, 2020). Drug diversion occurs when medication is redirected from its intended destination for personal use, sale, or distribution to others and includes theft, use, or drug tampering (American Nurses Association [ANA], 2021). When nurses divert medications from their patients, they put them in danger of experiencing unrelieved pain, receiving substandard care from impaired healthcare staff, and contracting infections from dirty syringes. The CDC (2019) recommends that healthcare facilities implement stringent security measures and prevention techniques to detect and intervene in medication impairment and diversion by nurses. Education regarding the recognition of drug diversion is an essential step in prevention.
Problem and Purpose Statement
Nurse drug diversion is an under-reported and challenging issue to identify and study. While experts and organizations agree that education and situational awareness are crucial to prevention, there are no standard mandated training programs in nursing curricula or hospitals. This doctoral project aimed to address the clinical question of whether an online educational offering about drug diversion would increase critical care nurses’ knowledge about the risks associated with drug diversion as well as the behavioral and physical signs of diversion, and what actions to take if they are concerned about a coworker.
An educational presentation was developed by the project lead and delivered online that utilized drug diversion prevention guidelines. The module was a PowerPoint presentation with embedded narration. The main topics were signs of diversion, common situations, and what to do if you suspect diversion. The project utilized a quasi-experimental, pre-test/post-test quantitative design to measure nurses’ beliefs, attitudes, and knowledge about drug diversion. Critical care nurses at the project hospital were emailed an invitation email which included links to the pre-test, the online presentation, and the post-test. Pre-test and post-tests were then evaluated for beliefs, attitudes, and knowledge changes.
Results of this pilot study demonstrate that healthcare organizations can utilize online education to impact knowledge, attitudes, and beliefs about drug diversion in nursing. Nurses completing the online module demonstrated an improvement in knowledge and change in beliefs and attitudes. Two questions showed a high baseline level of knowledge, thus no difference between the pre and post-test answers. The questions were “nurses who divert are always impaired at work” and “nurse drug diversion is typically motivated by a desire to sell drugs.” The main themes of the questions with the most significant changes involved identifying drug diversion and related behaviors, consequences of diversion, how the hospital system treats nurses who divert drugs, and available interventions (including the Washington State Health Professionals program). Additionally, participants’ responses to an open-ended question indicated they found the module to be helpful and brought awareness to a topic for which they had limited prior knowledge.
Studies indicate that increasing awareness and knowledge about nurse drug diversion is the first and most essential step in preventing drug diversion (Grower & Floyd, 1998; Nyhus, 2021, Alunni-Kinkle, 2015). Based on the results from this pilot study, the project hospital could implement a similar online education module for nurses during orientation and include it in its annual nursing education requirements. While the project hospital already has a successful pharmacy-based drug diversion prevention program, having a nurse leader involved in nurse education and follow-up might be beneficial. By providing nurses with this education, the organization is taking an essential step in prevention and reducing the events of nurse drug diversion.
By including an educational program about drug diversion in the orientation and ongoing nurse education, the organization would be taking the first and most crucial step in preventing drug diversion. Doing so can save costs and, more importantly, preserve the public’s trust and save the lives of both patients and nurses.
Alunni-Kinkle, S. (2015). Identifying substance use disorder in nursing. Nursing Management, 46(12), 53–54. https://doi.org/10.1097/01.numa.0000473512.38679.ca
American Nurses Association. (2021, May 6). Drug diversion in healthcare. American Nurse. https://www.myamericannurse.com/drug-diversion-in-healthcare/
Centers for Disease Control and Prevention. (2019). Risks of Healthcare-Associated Infections from Drug Diversion. https://www.cdc.gov/injectionsafety/drugdiversion/index.html
Grower, S. M., & Floyd, M. R. (1998). Nurses' attitudes toward impaired practice and knowledge of peer assistance programs. Journal of Addictions Nursing, 10(2), 70–76. https://doi.org/10.3109/10884609809041783
Morris, L. (2020). A real situation: Drug diversion in nursing. AACN Viewpoint, 42(1), 8–9.
Nyhus, J. (2021). Drug diversion in healthcare: Prevention and detection for nurses. American Nurse Today, 16(5), 24–27.
Solvang, Nicole, "Nurse Drug Diversion Prevention: A Pilot Project" (2023). Doctor of Nursing Practice (DNP) Scholarly Projects. 49.