Prescription drug diversion and employee abuse put the safety of patients and all ambulatory surgery center staff at risk, including nurses, physicians and administrators. Employee drug theft also is costly. According to the Insurance Fraud report “Prescription for Peril,” controlled prescription diversions cost public and private medical insurers an estimated $72.5 billion each year, which undoubtedly adds to the overall price tag of healthcare delivery. Opioids are the most frequently stolen medications in healthcare facilities, according to a 2012 Mayo Clinic study.  They are primarily used to feed an addiction, but in less common situations, they are sold for financial gain, the Mayo Clinic found. Damage from diverted drugs can include decreased patient safety due to an impaired employee as well as revenue loss from stolen medication or decreased work quality and productivity. Should an impaired staff member cause harm to a patient, both the employee and ASC leader are vulnerable to civil lawsuit. ASCs may be particularly susceptible to acts of drug diversion.

Unlike hospitals, ASCs do not house a pharmacy department to track medications, and consulting pharmacists may not always audit facility charts against narcotics records. There is often one ASC staff member in charge of ordering and re-stocking drugs, which could lead to a dangerous lack of accountability within the organization. The following are some useful signs and symptoms of drug theft and employee addiction within ASCs. Once employees have been introduced to this information, there is a short quiz to assess their knowledge and ensure a safer ASC environment for patients, staff and physicians.

Signs of theft

ASC staff have a legal and ethical obligation to report suspected activity to facility leaders. There are several ways an employee could divert medications within an ASC; theft of medication is not limited to taking pills when stocking and re-ordering. Rather, drug diversion can include theft of unopened vials or vials that have been tampered with, theft of residual drugs from a syringe or vial after having been partly administered to the patient, or theft of syringes or ampules that have been disposed in a “sharps” safety container. Nurses, physicians and ASC administrators can watch for the following signs that point to a discrepancy in the distribution of medication:

  • Multiple errors in the narcotic log system, ledger or chart;
  • Multiple patient complaints of inadequate pain control;
  • Destruction of narcotic invoices and count sheets; and
  • Inadequate drug wasting practices (not seeking a witness, asking someone to sign for a waste they did not witness, etc.)

Symptoms of addiction The American Nurses Association (ANA) estimates that 10 percent of nurses alone are dependent on drugs. This alarming number extends to physicians as well; a study by Gallegos et al, “Addiction in Anesthesiologists: Drug Access and Patterns of Abuse,” estimates abuse of opioids to be five times higher among anesthesiologists than the general public. Therefore, it is critical for all staff members to understand the key symptoms of drug abuse and to identify those in the workplace who may struggle with drug dependency and an inability to safely perform their job duties. The following signs are a list of common traits many drug abusers display:

  • Work absenteeism — An excessive amount of sick or no-show days;
  • Frequent disappearances from the worksite — Frequent trips to the bathroom or multiple breaks;
  • Excessive amounts of time spent near the drug supply or storage area;
  • Fluctuating work productivity — Inconsistent periods of high v. low productivity, as well as high-quality v. low-quality work;
  • Progressive deterioration of personal hygiene;
  • Sudden and heavy drug waste;
  • Sloppy recordkeeping — Multiple mistakes on the narcotic ledger or chart;
  • Wearing long sleeves when inappropriate;
  • Uncharacteristic personality changes and mood swings;
  • Patient or co-worker complaints about behavior;
  • Confusion, memory loss and difficulty concentrating; and
  • Increased isolation from others in the workplace.

These signs are not proof that an employee is abusing medication, but can point to some concerning behavior that may require intervention from an ASC administrator.

Responding to concerning behavior

Turning a blind eye to an employee’s erratic or suspicious behavior only enables potential abuse. If concerned about a co-worker, it is always best to discuss the issue with ASC leaders and administrators before approaching the employee in question. Remember, those who struggle with addiction can successfully recover and return as productive members of an ASC’s workforce. Ignoring their need for help, however, will only increase the risk of ASC staff and patient safety.

Educational quiz

The following quiz can assess employee knowledge of appropriate behavior and policies regarding drugs and impairment in the ASC workplace: Please circle the correct answer.

  1. Confusion and memory loss are signs of employee impairment.  T   F
  2. If an employee harms a patient while impaired due to drugs, the employer could be sued.   T   F
  3. It is okay to sign your name as the witness to a narcotic waste that you didn’t see take place.  T  F
  4. The most common type of drug that is diverted in any facility are opioids.  T  F
  5. Healthcare workers steal drugs to feed addiction more often than to sell for profit.  T  F

For more information regarding employee impairment or drug diversion within ASCs, please contact