Chain of Custody
Diversion
Public Health & Legal Implications
Workarounds & Practice Drift
RNs at the Frontline
100

RN Chain Of Custody 

What Is Who Had The Controlled Substance At What Time? 

100

Extended Time Off-Unit And Frequent Restroom Breaks

What Are Signs Of Possible Diversion? 

100
Critical Risk To Patient Safety 

What Is Impaired Practice? 

100

Omnicell 1st & 2nd log-in workflows of each day

What is User ID & Fingerprint Biometric, Followed ONLY By Fingerprint Access?  

100

Controlled substances removed from Omnicell by one RN may not be administered, returned, or wasted, by another RN except for this

What is an emergency situation? 

200

Chain Of Custody Begins And Ends 

What Is The Time Of Removal From Omnicell To Administration Into The Patient's Body? 

200

Multidisciplinary Approach To Controlled Substance Best Practices And Investigation 

What Is The Diversion Response Team? 

200

Healthcare Facilities And Clinicians are subject to this if controlled substances diverted from intended patient

What is insurance fraud charges? 

200

Co-signing Colleague's Waste At Omnicell When The Drug Waste Isn't Currently Present

What Is An Unwitnessed Waste Of A Controlled Substance? 

200

The 5 Transactions Requiring Real-Time, Biometric, Witnessed Waste 

What are Return, Waste, Restocking/Refilling, Cycle Count and Discrepancy? 

300

Failure To Do This Allows Another User To Access Omnicell Without Logging In  

What Is Closing The Drawer And Pressing "Exit"? 

300

Diversion Of Look-Alike, Sound-Alike, medications including paralytics

 What is diverter potential for self-harm? 

300

Hepatitis C

What Is The Most Prevalent Infectious Organism Transmitted In Healthcare Facilities Via Diversion Of IV Controlled Substances?   

300

FDA Criteria for Non-Retrievable, Water-Source, Controlled Drug Disposal.  

What is Steri-Cycle? 

300

Controlled Substance Waste Witnessed only in eMAR and not in Omnicell

What are Controlled Substances Medication Patches?

400

2 Medical Necessity Exceptions When Real-Time Patient Administration Of Controlled Substances May Be Delayed

What Are Patients Transported To A Procedure/Test Requiring PRN CS Administration Or Patients Requiring Frequent, Rapid, CS Dosing During A Procedure, Treatment, or Emergency? 

400

According To The National Council Of State Boards Of Nursing, This Is A Red Flag For Diversion 

What Are Variations In Controlled Substances Discrepancies Among Shifts Or Days Of The Week? 

400

The 3 Components Of Controlled Substance Access Privileges

What Are Prescribing, Dispensing From Omnicell/Retrieving From Pharmacy, And Administering?

400

According To The American Society Of Health-System Pharmacists (ASHP) This Is When An Investigation Is Launched 

What Is "Any Unresolvable Discrepancy"?  

400

Immediate Escalation To Nurse Leader, Nursing Supervisor, Security And Completion Of A RISQ Report

What Is The Unaccounted For, Or Unexplained Loss Of, ANY Amount Of A Controlled Substance? 

500

Leaving a controlled substance anywhere unattended, including at the patient's bedside. 

What Is a break in the Chain of Custody? 

500

Environmental risk to staff from diversion 

What are needle sticks? 

500

The DEA, BNE, and DOH may opt for this if diversion suspected or discovered 

What is heightened surveillance? 

500

Neuroscientists And The Evidence 

What Is The Hard Wiring Of The Human Brain To "Drift" From Safe Practices In All Aspects Of Life And Work? 

500

The maximum time frame for an RN to enter a verbal or transcribed order for, and document administration of, an override medication. 

What is 1 hour? 

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