CFPN Drug Diversion Investigation and Prevention 2 — Questions and Answers
Question 1: A nurse is found to be diverting fentanyl by replacing it with saline in patient syringes. What patient safety risk does this create beyond the diversion itself?
- Patients receive inadequate pain control and may be exposed to blood-borne pathogens (Correct answer)
- Patients receive double doses of the medication
- The saline causes an allergic reaction
- Documentation errors are created in the medical record
Correct answer: Patients receive inadequate pain control and may be exposed to blood-borne pathogens
Saline substitution leaves patients in pain without adequate analgesia and introduces infection risk through needle tampering.
Question 2: Which Schedule II controlled substance is most commonly associated with healthcare worker diversion in the US?
- Oxycodone and fentanyl (Correct answer)
- Marijuana
- Heroin
- Methamphetamine
Correct answer: Oxycodone and fentanyl
Oxycodone and fentanyl are the most frequently diverted Schedule II drugs by healthcare workers due to accessibility in clinical settings.
Question 3: What does 'wasting' a controlled substance mean in the hospital context, and why is it forensically significant?
- Discarding unused medication with a witness, significant because fraudulent wasting is a primary diversion method (Correct answer)
- Disposing of expired medications, significant for environmental compliance
- Returning unused medications to pharmacy, significant for cost savings
- Administering only part of a dose, significant for dosing accuracy
Correct answer: Discarding unused medication with a witness, significant because fraudulent wasting is a primary diversion method
Wasting is the witnessed disposal of unused controlled substance; falsifying waste records is a common method of concealing diversion.
Question 4: During a drug diversion investigation, a forensic pharmacy nurse conducts a peer comparison analysis. What does this involve?
- Comparing a suspect nurse's controlled substance access patterns to peers with similar patient assignments (Correct answer)
- Interviewing the suspect's nursing peers for character references
- Comparing medication error rates between nurses
- Reviewing the suspect's educational background
Correct answer: Comparing a suspect nurse's controlled substance access patterns to peers with similar patient assignments
Peer comparison identifies statistical anomalies in controlled substance access that deviate from colleagues with comparable patient loads.
Question 5: Which body should a hospital notify when a healthcare professional is confirmed to have diverted controlled substances?
- State Board of Pharmacy, State Board of Nursing, and the DEA (Correct answer)
- Only the state board of nursing
- Only the hospital's human resources department
- Only the patient's family
Correct answer: State Board of Pharmacy, State Board of Nursing, and the DEA
Confirmed diversion requires multi-agency reporting to regulatory boards and the DEA as mandated by state and federal law.
Question 6: What is the purpose of a Prescription Drug Monitoring Program (PDMP) in forensic pharmacy nursing?
- To track prescriptions for controlled substances across prescribers and pharmacies to detect misuse patterns (Correct answer)
- To monitor only inpatient controlled substance administration
- To replace automated dispensing cabinet records
- To manage insurance reimbursement for controlled substances
Correct answer: To track prescriptions for controlled substances across prescribers and pharmacies to detect misuse patterns
PDMPs are state databases that track controlled substance prescriptions and dispensing to identify doctor shopping and diversion patterns.
CFPN Drug Diversion Investigation and Prevention 2
A nurse is found to be diverting fentanyl by replacing it with saline in patient syringes.
What patient safety risk does this create beyond the diversion itself?