Drug diversion in a nursing home can have serious consequences and pose a risk to resident and staff health and safety.  Facilities and their nursing staff are expected to be the gatekeepers of medications as a key component of ensuring quality care.   Effective medication management includes mechanisms for storing, administering, and maintaining accurate documentation of medications. Drug diversion occurs when medications are obtained illegally.  Consider these steps for preventing drug diversion in nursing homes…

  1. Implementation of strong policies and procedures for medication management:
      • A nursing home should have policies and procedures in place to address the handling, administration, and storage of medications. For example, medications that are considered controlled substances should be kept in a separate locked location and counted between oncoming and outgoing nursing staff prior to medication keys being passed off. Along with this, a controlled substance log should be signed by both parties ensuring the count is accurate. Staff should not pass off or accept responsibility if the count of the log does not match the medications on hand.
  1. Screen employees:
      • Providing proper screening of employees prior to hire is an important step in helping to prevent diversion. Screens are multifaceted and may include activities such as background checks, verification with applicable licensure board(s), drug testing and reference checks. While reference checks rely on the employee for providing information, they can be strengthened by requesting professional contacts only and encouraging the use of a past direct manager/supervisor. In addition to effective screening processes, educate staff on identifying potential signs and behaviors which may indicate substance abuse.
  1. Monitor medication use:
      • Regularly audit medication records to detect discrepancies as this may help with early identification of potential drug diversion. Check to be sure that patterns of PRN medication usage corresponds with documentation in the medical record, and that medications are being used for their intended purpose. Is there follow up documentation showing medication effectiveness, or is the resident continuing to have complaints of pain? Also, monitor to determine if PRN usage increases when a specific person is on duty.
  1. Limit access to medications:
      • Limit access to only those staff members who need the medications to perform their job duties. Medications should be kept in a secure, locked area, and staff members should only have access to the medication they need to administer. Some tips include (1) keeping the med cart locked when not supervised or in direct sight of vision and (2) remove all discontinued medications from the cart and storage room promptly.
  1. Limit drug wasting:
      • Encourage pharmacies to send the most accurate dose possible, ideally single use doses when available, to limit wasting of medication. Monitor to ensure staff members follow medication wasting policies and procedures and that there is always a witness when wasting does occur.
  1. Encourage reporting:
      • Encourage staff members to report any suspected drug diversion or medication errors. Teach staff to recognize signs that may indicate abuse such as medications not signed on both the medical record and the controlled substance log (or any other sloppy record keeping), extended time away from job duties, or an increase in the amount of PRN medication being used without documented justification.  Establishing an open reporting culture can help to identify potential issues early on and address them before they become more serious.

By implementing these steps, nursing homes can help prevent drug diversion and improve medication safety for their residents.


Contact Proactive for a review of your drug diversion prevention efforts or to schedule a mock survey.


Written By: Nancy Casperd, BSN, RN, CHC
Clinical Consultant

Was this article helpful? Access weekly insights when you sign up for our weekly newsletter!