Training Materials
Content outlines for staff training — new hire awareness, annual competency, red flag recognition, and proper waste documentation.
New Hire Diversion Awareness Training
Required for all new employees with any access to controlled substances. Delivered within the first 30 days of hire. Duration: 30-45 minutes.
Training Outline
1. The Scope of the Problem
- How healthcare workers divert — national statistics
- Impact on patients (pain mismanagement, infection risk)
- Impact on the diverter (license, career, criminal liability)
- Impact on the organization (regulatory fines, reputation)
2. Your Role in Prevention
- Proper medication handling — every time, no shortcuts
- Waste documentation requirements
- Securing medications at all times
- Never share login credentials or badges
3. Reporting Concerns
- How to report — anonymous reporting mechanism
- What to report — discrepancies, behavioral concerns, policy violations
- Non-punitive culture — reporting is not retaliation
- What happens after a report (investigation process overview)
Annual Competency Training
Required annually for all CS-touching staff. Builds on new hire content with deeper case studies and organizational-specific data. Duration: 45-60 minutes.
Required Content
- Organizational diversion metrics over the past year — total discrepancies, investigations, outcomes
- Lessons learned from any confirmed diversion events in the organization or region
- Policy updates since last training
- Case study — real diversion scenario with discussion questions
- Waste witnessing demonstration and return-demonstration
- Behavioral observation — signs of impairment (video or role play)
Common Training Gaps
- Annual training that is identical to new hire training — staff tune out. Use case studies, not slides.
- No unit-specific content — ED diversion differs from OR diversion. Tailor examples.
- No knowledge check — reading slides is not training. Use scenarios and test comprehension.
- Training completion tracked but not effectiveness — measure whether staff can identify red flags after training.
Red Flag Recognition — By Category
| Category | Red Flags | What to Do |
|---|---|---|
| Behavioral | Volunteers to administer CS for colleagues; frequent bathroom breaks after handling CS; unwilling to take breaks; arrives early / stays late frequently; defensive when CS policies are discussed | Document specific observations with dates/times. Report via confidential mechanism. Do NOT confront. |
| Transactional | High override rate; high waste rate; frequent admin-access transactions; removing CS under wrong patient; multiple removals from same cabinet in short window | Review ADC reports. Compare to unit/peer averages. Flag if > 2 SD from mean. Cross-reference with camera footage. |
| Documentation | Waste documented without witness; administration charted when patient reports no effect; pain scores don't change after CS administration; documentation timestamps outside normal workflow | Audit MAR against pump logs. Review waste documentation for missing witness fields. Check for timing anomalies. |
| Physical | Track marks on arms/legs (long sleeves worn in warm environments); pinpoint pupils or dilated pupils; runny nose/nosebleeds; tremors; excessive yawning; drowsiness during shift; odor of alcohol | Document observations. Report to supervisor immediately. Do NOT accuse. Initiate fit-for-duty evaluation. |
| Inventory | Controlled substance counts consistently off; narcotic waste not matching dispense records; expired CS not returned on schedule; ADC restocking discrepancies | Escalate to pharmacy management. Conduct focused perpetual inventory review. Review ADC transaction logs for pattern. |
Waste Documentation Training
The most diverted medications in healthcare are never reported missing — they're documented as waste. Proper waste witnessing is the single most effective behavioral control.
Proper Waste Witness Procedure
Prepare
Witness confirms the medication name, dose, and route. Verify against MAR.
Observe
Watch the entire destruction — medication placed in waste receptacle, residual volume visible.
Document
Witness documents the waste event in the ADC/EHR with their credentials. Includes time, drug, volume, and method of destruction.
Reconcile
Waste volume reconciled against dispense volume at shift change and ADC restocking.
NEVER pre-sign waste documentation. NEVER witness waste you didn't physically observe. NEVER document waste for a colleague who is not present. Falsified waste documentation is grounds for termination and may result in criminal charges.
Impairment Recognition — Signs of Substance Use in Healthcare Workers
Behavioral Changes
- Mood swings — irritability, euphoria, depression
- Isolation — avoiding colleagues, eating alone, hiding
- Defensiveness when questioned about medication handling
- Frequent absences, especially after days off
- Declining performance or increased errors
- Volunteering for extra CS-related tasks
Physical Signs
- Pinpoint or dilated pupils
- Runny nose, frequent nosebleeds (insufflation)
- Track marks — long sleeves in warm environments
- Tremors, unsteady gait, poor coordination
- Excessive yawning, drowsiness during shift
- Weight loss or flushed skin
Practice Changes
- Waste documentation errors or missed witness signatures
- Overrides significantly above peer average
- Requests to cover high-opioid patient assignments
- Patients reporting inadequate pain relief despite charted medication
- Signing out CS under wrong patient then correcting later
- Frequent ADC transactions outside normal workflow
Incident Reporting — How It Works
What to Report
You don't need proof. You just need a concern.
- You see a colleague waste CS without a witness
- A patient reports they didn't receive pain medication that was charted as given
- You notice a colleague behaving differently after handling CS
- Controlled substance count is off and you can't find the discrepancy
- A colleague asks to borrow your login or badge
- You find a syringe or vial in an unexpected location
How to Report
Multiple reporting channels — use whichever you're comfortable with.
- Anonymous hotline/portal — no name required, available 24/7
- Direct to supervisor — in-person or email
- Pharmacy leadership — call or email the diversion officer directly
- Incident reporting system — file a medication event report
Non-punitive culture: This organization has a zero-tolerance policy for retaliation against anyone who reports a concern in good faith. If you experience or witness retaliation, report it immediately.