Partially Filled Vials and Syringes in Sharps Containers Are Key Sources of Problems
By the Institute for Safe Medication Practices
A 36-year-old hospital care aide (nursing assistant) who had been diverting discarded drugs died after self-administering what she likely thought might be an opioid but was actually a neuromuscular blocking agent (Fayerman, 2016a-c). The aide had found an unlabeled syringe containing a clear solution in a biohazard box, injected the solution, and suffered immediate paralysis, respiratory arrest, and then death. The aide’s death happened in Vancouver, Canada. It is a very sad and cautionary story that should serve as a wake-up call to all U.S. hospitals to take the necessary steps to prevent and detect the theft and abuse of hospital medications.
According to news reports (Fayerman, 2016a-c), the aide, Kerri O’Keefe, had worked in the emergency department (ED) for about 15 years, and by all accounts, she loved her job and was extremely well liked and respected by her colleagues. She had a long history of drug and alcohol dependence and had been placed on leave twice before, but was allowed to return to work after stints in rehab. However, she concealed the breadth and depth of her addiction from both her family and her colleagues and friends at work. When Kerri did not show up for a planned family event, her mother went to her apartment and was shocked to find her daughter dead and her apartment littered with an arsenal of used syringes, vials, needles, and tourniquets. Many of the syringes included patients’ names and dates. Investigators also found stolen urine samples from patients in the refrigerator, presumably to use if she was asked to provide a urine sample for drug testing.
The hospital had numerous physical controls in place to prevent unauthorized access to controlled substances in automated dispensing cabinets (ADCs), locked cabinets, and pharmacy vaults. The hospital also required periodic counts of controlled substances and documentation when removing them from storage locations. Kerri was able to gain access to drugs despite the existing safeguards because she stole discarded syringes, vials, and patches that contained leftover drugs from biohazard boxes. Most boxes were attached to the outside of locked cabinets but could be removed easily.
Based on the drug supplies found in her apartment, it appears Kerri would collect a stockpile of medications, especially leftover morphine and fentaNYL, and then secretly inject the medications at home. It appears she also self-injected drugs in unlabeled syringes, perhaps hoping the drug was an opioid, but on the day of her death, the drug was rocuronium. The unused syringe containing the neuromuscular blocking agent had been discarded in a biohazard box after a planned intubation in the ED was cancelled. According to investigators, the aide had been stealing entire biohazard boxes or emptying the boxes into a backpack or small suitcase on wheels that she routinely took to work (Fayerman, 2016a-c). Despite security cameras, her actions were never discovered prior to her death. Based on news reports, Kerri’s August 2015 death occurred around the time that she was due to take another leave of absence to attend a third round of rehab for her addictions (Fayerman, 2016c).
Drug overdoses are the leading cause of accidental death in the United States, and opioid addiction is driving this epidemic, with more than 18,893 overdose deaths in 2014 (National Center for Health Statistics, 2015). Of the 21.5 million Americans 12 years or older who had a substance use disorder in 2014, 1.9 million involved prescription pain relievers; far fewer were abusing heroin (Center for Behavioral Health Statistics and Quality, 2015). The latest data from the U.S. Substance Abuse and Mental Health Services Administration showed that about one in every 10 health professionals is struggling with addiction or abusing drugs not prescribed for them (U.S. Department of Health and Human Services, 2015). Very few healthcare workers who are diverting and abusing drugs are ever caught, often despite clear signs in physical appearance, thoughts and behavior, and performance. The American Nurses Association reports the same—about 10% of nurses are thought to be abusing drugs and may be caring for patients while impaired (Copp, 2009). These incidence rates mirror the general population, meaning healthcare workers are not at higher risk of drug abuse than the general population. However, the overall pattern of drug abuse and dependency with healthcare professionals is unique (Thomas & Siela, 2011).