Q: Is it true that high turnover among nurses increases the risk of drug diversion?
A: Yes, high turnover in skilled nursing facilities can result in increased risk of drug diversions.
According to the Centers for Medicare & Medicaid Services, facilities with the lowest (1-star) rating had median turnover of 135.3%, while the best (5-star) facilities had turnover of 76.7%. By comparison, hospital turnover rate was 19.5% during the same period in 2022.
High turnover rates lead to staff with short tenure at the facility who are much more likely to be unfamiliar with facility policies and procedures. This lack of awareness and unfamiliarity with facility practices can be easily exploited by diverters, who can use the inexperience of novice staff members as an excuse for their poor medication practices.
Facilities with high turnover also become a target for diverters who want to quickly move on to their next target. To be clear, drug diversion can occur at facilities whether turnover is high or low. However, facilities should be concerned and make extra inquiries when a nurse has been employed at multiple facilities for noticeably short periods of time.
Another indicator of increased risk for drug diversion is the use of paper medical charts. Paper records are much easier for diverters to manipulate and more difficult for diligent facility leaders to detect since there is no electronic audit trail. Electronic records are immensely helpful in identifying inconsistencies and errors.
It is critical that skilled nursing facilities have a strong program in place to prevent, monitor and detect drug diversion. Collaborate with legal counsel to develop proper protocols to comply with state and federal statutory and regulatory requirements. Then aim to further strengthen drug diversion prevention by reducing turnover among nursing staff.
Please send your legal questions to Norris Cunningham at [email protected]
