The Diversion Blind Spot Nobody Is AuditingThe Diversion Blind Spot Nobody Is Auditing
Drug Diversion Insights with Terri Vidals
Terri Vidals explains how cancelled medication orders, especially for non-controlled drugs, can conceal serious diversion schemes in healthcare. She shares practical auditing tips and a real case example to highlight why cancel data and bedside vigilance matter.
6:34•3 Jun 2026
The Diversion Danger Hiding in Cancel Transactions
Episode Overview
- Most diversion analytics tools focus on controlled substances, leaving cancel transactions and non-controlled drugs largely unchecked.
- Cancel activity can hide dangerous schemes such as returning tampered vials and substituting non-controlled medications for controlled ones.
- Relying on patient outcomes alone can delay detection, as individual cases often appear as isolated incidents rather than a clear trend.
- Every staff member with access to controlled substances should routinely inspect vials and packaging for signs of tampering as a standard workflow step.
- Regular manual review of cancel data by user, shift and medication type can reveal clusters that automated dashboards miss.
“Cancels are exactly the mechanism that enables two of the most dangerous diversion schemes.”
What can we learn from those who have battled addiction within healthcare itself? This short episode zeroes in on a risk most teams barely glance at: cancel transactions. Pharmacist and drug diversion specialist Terri Vidals breaks down how cancel activity, especially on non-controlled medications, can hide serious diversion patterns.
She explains that most analytics tools are wired to watch controlled substances, so “cancels on non-controlled substances, they're not even on the radar at all.” That gap creates a perfect hiding place for diverters. Terri walks through two high-risk schemes: returning tampered vials to inventory and swapping a non-controlled sedating drug for a controlled one the patient was supposed to get. On paper, everything looks fine.
The controlled substance data behaves, the dashboards stay quiet, and the cancel entries read like harmless “oops, fat finger” moments. She then shines a light on the bedside reality. How many patients might receive saline instead of fentanyl before anyone connects the dots? Different shifts, different nurses, different diagnoses – each case looks like a one-off.
Terri stresses that “every staff member with controlled substance access has to be part of the detection system,” from diversion specialists to nurses checking vial tops, fluid appearance and packaging as a deliberate step, not an afterthought. To ground it all, she shares a candid story about a nurse she audited for nearly two years. Only after patient interviews and a closer look at cancelled Tylenol orders did the pattern finally click.
Terri openly admits, “I learned my lesson at that moment, and I should have learned it a lot sooner.” If you work in healthcare and think your monitoring tools catch everything, this episode might have you asking: what are your cancel transactions hiding?
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