How to conduct effective interviews: A drug diversion investigation checklist

81% of hospital leaders believe that drug diversion occurs and is largely undetected, posing risks to patient safety and organizational compliance, as well as nurses’ well-being. Drug diversion interviews must balance compliance with uncovering incidents and supporting recovery.

The interview is a key part of the drug diversion investigation. In this article, we set the stage for the interview, asking the key questions to find out what happened, but also infusing the process with empathy and care. Using this drug diversion investigation checklist, you can prepare for and conduct the interviews effectively, learn how to look for behavioral cues leading to key moments throughout the interview that lead to more productive outcomes, and avoid common pitfalls that may hinder the investigation.

Drug diversion investigation checklist

Each section of this piece will dive deeper into how to prepare, conduct, and follow up on your drug diversion investigation questions, but at the core of every investigation is the interview. Here is the basic checklist of what you want to achieve in your interview.

• Clearly and confidently explain why you are interviewing the person suspected of diversion
  • Provide minimal time for the individual suspected of diversion to prepare for the interview
  • Less warning often results in more genuine reactions to questions
• Allow suspect to explain or justify actions, observing gaps in explanation
• Return to the gaps in the suspect’s story, directing the questions back to the inconsistencies
• Be aware of body language and indicators of deception or escalation
• Present choices (“fork in the road moment”) and reiterate the purpose of interview
• Explain next steps and conclude with documentation

The two most essential elements of any investigation are finding out the truth and rooting the entire process in compassion. Drug diversion has multiple victims: the patient and the person diverting. If you can gather the truth as indicated by the evidence and keep your approach centered on healing, you can balance empathy and effectiveness. This will help you keep compassion for the people you care about, and stay compliant with regulatory requirements.

Interviews versus interrogations

Because it is often referred to as a drug diversion investigation, there is already a negative connotation to the act. We never want the suspected diverter to feel interrogated. However, when it is time to speak with them, you have to borrow elements from a standard interview and an interrogation. An interview is a dialogue that seeks to gather information, and most importantly, it is non-accusatory, informal, and intent on understanding the situation. An interrogation aims to confirm your suspicions and is conducted to confirm guilt; it is accusatory and a formal process.

At its core, your interview should include the intent to establish the facts surrounding the incident and create an environment that encourages transparency and honesty. However, drug diversion can have a significant impact on your organization. The stakes are high. There are risks to patients and staff, as well as regulatory implications and potential inspections. Due to the gravity of the situation, the dialogue must still center around confirming what the data and evidence suggest. Due to the confrontational manner of this conversation, it is recommended that you take a more formal approach and pick a location that will be conducive to this conversation.

Finally, think about what the post-interview will look like before you speak to the subject. You can never know the outcome of a drug diversion investigation, but you can plan for different outcomes. The subject could admit to the diversion and ask for help, they may emphatically deny everything despite the data, or there may be physical and/or verbal escalation, resignation, or no-showing. You want to know what your next step will entail, whether it is providing support, suspension, termination, or another outcome.

Observation

From the moment the subject walks in and sits down, you really want to observe them. This is crucial to the success of the interview. Recognizing behavioral changes like shifting body language or signs of deception can guide you during the interview.

Take note of those moments. Observing and documenting the individual’s responses, their inconsistencies, the gaps in their story, or the falsehoods they tell. These all become your compass for moving the interview forward.

Direction

Direction determines destination. It is important to remember to avoid making assumptions and leave emotions at the door for these conversations. When observing with emotion, you look for signs to affirm assumptions. If you think someone is innocent or guilty ahead of time, you manipulate the evidence towards this assumption. By letting the interviewee steer the conversation through their responses and behavior, you can prioritize admission and support, and are more likely to get a confirmed diversion.

Ending with empathy

The goal of every drug diversion investigative interview should be to support the interviewee. The confrontational element of the interview can lead to emotional escalation. The subject can often express anger, fear, or sadness, but you don’t want to escalate with them. Remember that addiction is a disease.

The drug diversion conversation often centers around patient safety and harm, but the subject often becomes a patient themselves. Begin and end these interviews by stating the purpose is to help. The drug diversion program, which sits inside your organization, is an advocate, unlike the regulatory agencies that seek sanctions and fines. Make sure to have the resources and information on hand to support the diverters seeking it. This step should happen immediately.

Case studies and real-world applications

This article discusses the details of an interview, but what does this look like in practice? We examine two scenarios that highlight the necessity of considering the physical environment.

Scenario 1: Intensive care unit

The investigative process required the first interview to be conducted by the direct supervisor, in this case, the nurse manager. The interview was conducted in the nurse manager's office. Unfortunately, this was a very visible location in the center of the ICU where the interviewee worked. Escalation happened quickly, and profanity and verbal abuse were being flung at the nurse manager. At this point, the nurse was requested to turn in their keys and ID badge. They threw the items at the nurse manager, and security was called. Due to the proximity to the ICU, the incident was seen and/or heard by patients, family members, and staff.

Scenario 2: Emergency department

The interview took place outside of the department in an administrative wing with the chief nursing officer and a third-party designated interviewer. However, the interviewer and the CNO placed the subject between themselves and the exit. In this case, the nurse also got aggressive. He was a 6’ 3” and 300lb man who barricaded himself in the office when the interview was not going his way. Thankfully, due to the isolated location and a panic button, security was able to come and de-escalate the situation away from the public eye.

In both cases, there was a lack of spatial awareness, either in terms of location or placement within the room. This further points to the need to prepare and think through every detail before starting the interview.

How drug diversion tools support your program

64% of respondents to a survey stated the most significant challenge is spending excessive time gathering data before initiating an interview¹. The hardest part of the investigation is making sure we are ready to initiate the conversation. This is where Sentri7 Drug Diversion can improve your investigation. Our AI-driven software enables earlier detection and provides you with a heat score that highlights patterns of diversion.

This article is based on the webinar we hosted in May 2025. If you would like to learn more valuable insights, personal stories, and robust Q&A from that webinar, you can watch the full video below.