Narcotic Accountability in Long-term Care: A DON's Worst Nightmare is Drug Diversion

Listen boo — if there’s one thing that will make any Director of Nursing’s stomach drop, it’s drug diversion.

Especially the moment you go to count, and something is off.

Call it what you want. Question it how you want. But if the narcotic count isn’t matching the log?

Consider it missing until it is proven otherwise.

And you already know my favorite line: "It’s not about what you know. It’s about what you can prove. "That mindset is EXACTLY how you protect your patients, your license, and your facility when it comes to controlled medications.

Because when narcotics are not handled properly, the DON, the nurse, and the facility wear the consequences.

Today, let’s walk through best practices that every nursing leader should enforce — no excuses, no shortcuts — when it comes to narcotic handling in long-term care.

🚨 Why Narcotic Control Matters

Drug diversion in healthcare isn’t just a policy violation — it’s a regulatory, legal, and ethical nightmare.

Missing pills can be:

• staff diversion

• resident misuse

• improper waste

• documentation errors

• or straight-up fraud

  
  

Surveyors don’t play about controlled meds, and neither do state boards. Your count sheet, your documentation, and your physical narcotic packs ALL tell the story.

If one doesn’t match the other, that story becomes an investigation.

📝 Best Practices for Preventing Narcotic Diversion

1️⃣ When Narcotics Are Received, Check Them In Immediately

Do not tuck them into the cart to “check later.”As soon as controlled meds hit your hands:

• verify the resident name

• med name

• dosage

• quantity

• expiration date

• blister pack integrity

• refill details

  
  

The narcotic log MUST match the physical package.

If anything is off — ANYTHING — notify the DON and pharmacy immediately. No waiting. No assumptions. Fix it right then.

2️⃣ Always Sign at the Time of Administration

I don’t care how busy you are — never wait until the end of the shift to sign out narcotics.

When you give it:

• document it

• sign it

• verify count

Delaying documentation is the quickest path to errors, suspicion, or diversion accusations.

Your charting is your defense.

3️⃣ If You Leave the Facility, Count Before You Exit — AND When You Return

Lunch break?

Emergency?

Shift split?

Step off the property? Count.

And when you walk back through those doors?

Count again.

I know it sounds strict — and yes, it is. But I don’t trust a single soul when it comes to narcotics. Protect yourself with confirmation, every time.

4️⃣ Resident Refuses? Waste Immediately — According to Policy

A refusal is NOT:

• “I’ll waste it later”

• “I’ll just mark it”

• “I’ll leave it in the cart”

No ma’am.

If a resident refuses a dose:

• follow policy

• waste with another licensed nurse present

• document the waste immediately

• verify a witness signature

Again — prove what happened.

5️⃣ Discharge or Discontinued Orders? Dispose IMMEDIATELY

Leaving discontinued narcotics in the drawer is the fastest track to:

• diversion

• missing pills

• survey citations

• pharmacy write-ups

• and a DON headache you do NOT want

  
  

Those meds should never sit and “wait for someone to deal with them.”

Remove. Dispose. Document. Done.

6️⃣ During Narcotic Count — Verify BOTH

You aren’t just confirming that the number matches.

You are also checking:

• the narcotic count sheet

• the blister pack

• the medication label

• the pack condition

• pill pocket integrity

• signs of tampering

If you see:

• cracks

• scratches

• tears

• opened seals

• cuts

• repackaged pills

• 
  

Pause the count, notify the DON, and document.

It takes seconds to check. It takes months to survive a diversion investigation.

🔍 Need to tighten up your narcotic process?

Do some spot checks today. I guarantee you’ll find areas of opportunity — and baby, when you see them, correct them immediately, educate your team, and follow through.

Because narcotic integrity isn’t random. It is a system One built on consistency, accuracy, accountability, and documentation.

💡 Final Leadership Reminder

Every facility may have its own policies. Every state may have its own regulations.

But whatever your policy IS?

Baby, make sure you follow it.

Don’t get relaxed. Don’t get casual. Don’t assume "It’ll be fine."

Accountability is the only way to stay compliant, keep residents safe, and protect your license.

Build a culture of narcotic integrity.

Train your staff to follow best practices every single time.

And count like your career depends on it — because one day it might.

Lead with Love 💜

yourfavnurseleader

Bilquis Ali