Narcotics

I want to start this post by saying “Oops, it happened again.” The problem is, I shouldn’t have to blog about this topic considering how serious it is and the potential risk to patients.

I live in Colorado. In February, 2016, it hit the news that one of the Denver areas largest hospital, Swedish Medical Center, was testing close to three thousand patients for possible exposure to HIV and Hepatitis after a surgical tech was suspected of diverting drugs.

What is drug diversion? Drug diversion is using a narcotic for anything other than its intended use. The most mildest form is not wasting drugs properly. It requires two licensed personnel to waste a drug and sometimes you just can’t find another person at that moment and then you forget. Not excusable but understandable. The most serious form is healthcare workers using the drug themselves and not giving them to the patient or using the “waste” or overage for themselves.

The problem is, a relatively similar scenario happened at another Colorado hospital in 2008 and 2009. This was the case of Kristen Parker, a surgical tech who is currently serving a thirty year prison term for infecting three dozen patients with Hepatitis C. She was stealing unlocked Fentanyl set aside for surgery, injecting it into herself, and then drawing up saline into the same syringe where then an unsuspecting provider injected it into the patient causing transmission of the virus.

In fact, one of the anesthesiologists involved in this case went public and even wrote a novel based upon her experience. This wasn’t a quiet news story.

In this blog piece from The Daily Beast in February, 2013, Gorman states:

“At that time, we didn’t think about locking drawers,” she says. “No one ever told me I was doing anything wrong. If there were rules to enforce locking the drugs up, they were not enforced.” Rose has said it sent memos to its anesthesiologists in 2001 and again after Parker’s crime, warning them “never leave controlled substances unlocked or unattended.”

In light of this incidence, it is unbelievable to me that a case of suspected drug diversion involving a surgical tech could happen again in this state and it makes me wonder if potentially the same process of drug diversion was used as Kristen Parker employed– unsecured narcotics awaiting injection for surgical procedures.

The tech, Rocky Allen, has been arrested and has pleaded not guilty. Thus far, it appears two patients have tested positive for Hepatitis B.— although the hospital currently denies they transmitted the virus as part of this case.

So please, hospital OR’s everywhere, can we please develop a system where narcotics can be dispensed safely to surgical patients?

I was happily reading along one of my favorite best-selling authors when I stumbled upon a troubling set-up. Now, this author makes a lot of money which is why I’m not sure the reason for his not picking up the phone to consult me on his manuscript.

One character had been beaten up fairly well. He was in the hospital on a Valium drip. Huh? That’s right, just a bag of Valium hanging and dripping into his veins.

Issue One: Valium is not a pain medication per se. It is a muscle relaxant which can relieve pain from a muscle spasm. However, if you have had the snot beat out of you, let me introduce you to my friends the opiates: Morphine, Fentanyl, etc. These are likely what we would give first for pain.

Issue Two: Valium is not given in a bag as a drip. In fact, I can think of few instances where Valium would be given as a continuous medication. Some shorter acting friends of Valium are– but you generally have to be in the ICU on a ventilator to get some. This character was not.

Issue Three: Narcotics need to be secure. If a patient needs a continuous amount– this is what PCA (patient-controlled analgesia) pumps were made for. They are locked IV pumps so that no one can steal the drug from the bag and so that the patient cannot manipulate how much they receive.

Pediatric ICU’s do run a lot of continuous drips that are not locked. In these instances, usually a calculation is made at the end of a shift to look at the amount remaining. If the syringe is off by more or less one millimeter– then generally an incident report is filled out.

So bestselling, multi-million dollar author— really, just call me up. I’d be happy to help.

Have you read a scene with inappropriate use of narcotics?