LogicStreaming Blog

Patrick Yoder

Patrick developed a passion for innovation reengineering bicycles to better suit the needs of childhood. He started his career in medical research, then as a Clinical Pharmacist and an Informatician. He developed experience leading innovative teams at Wolters Kluwer Health as the Vice President of Informatics and Clinical Development. There he spearheaded the creation of a solution that established the company as the recognized leader in the market within four years. He also led the informatics team at Hennepin County Medical Center before co-founding LogicStream Health. Patrick enjoys scuba diving, running and cycling in his time away from LogicStream Health.
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The Drug Diversion Epidemic – Part 4: Technology Solutions

Posted by Patrick Yoder on Jan 16, 2020 11:45:00 AM

Part 1 of this drug diversion blog series focused on the ways healthcare workers gain access to and redirect controlled substances. Part 2 explored the actions hospitals are taking to address the problem. Part 3 examined why some hospitals may be slow to act, and what happens when their response is delayed. In this blog post, we’re taking a closer look at how hospitals are using technology to help detect drug diversion.

Market need

Given that many health systems still rely on a largely manual approach to detect occurrences of drug diversion, there is a demonstrated need for effective technology solutions to make the process more efficient. Currently, diversion detection teams at many health systems pull spreadsheet data from multiple systems and undergo time-consuming reconciliation processes such as comparing individual line items to detect discrepancies. When the need for an investigation is identified, several more weeks may be required for staff to comb through historical data looking for patterns. The amount of time it takes to monitor and investigate incidents of drug diversion is a major pain point across the healthcare industry. This is especially true for pharmacy and compliance teams charged with pulling data from disparate sources and manually aligning the information to support any resulting investigations.

Technology solutions provide early warning

Healthcare systems are now turning to technology to manage diversion surveillance by tracking patterns in HCW documentation and medication dispensation and administration reports that can uncover signs of drug diversion. These software tools speed up monitoring and detection processes by allowing timely review of data. The focus of these technology solutions varies based on the expertise of the companies that create them. Some have a background in information security, while others have experience with automated dispensing cabinet (ADC) systems.

Our unique expertise allows us to take a different approach. LogicStream Health’s clinical process improvement platform helps clinical teams drive standardization and high reliability in order to improve quality and safety while reducing costs. We do that by providing visibility into medication procurement, utilization, movement, dispensation, administration and wasting across the clinical continuum. Our clinical process improvement platform and The Drug Shortage App are already being used by hundreds of hospitals around the country. These products deliver valuable insights into some of the most pressing problems that clinical teams face, such as drug shortages and more.

Automated assessment and notification

How are we applying that approach to the problem of drug diversion? LogicStream Health’s solutions can integrate disparate sources of data in near-real-time from multiple technology platforms within a hospital system, including the electronic health record (EHR) system, automated dispensing cabinets, narcotic storage systems, and more. The Drug Diversion App from LogicStream Health™ uses this data to synthesize an assessment of identified signals that highlight potential risk and problem areas including active surveillance of drug ordering, dispensation, administration and wasting activities, and documentation anomalies.

Automated notifications provided by The Drug Diversion App such as alerting health system diversion teams to signals indicating potential risk for diversion are the key. By identifying early warning signs of diversion or irregularities in practice, The App enables hospital systems to respond quickly and determine the need for intervention rather than waiting for the time-consuming reconciliation of ‘old’ data.

Efficient investigation

When an investigation is warranted, The App facilitates efficient task management and reporting of the process. The App serves as an ‘all-in-one’  diversion monitoring tool for efficient collaboration and communication across distributed health system teams, including views for comparison and benchmarking investigative tools that allow for collaboration across departments and clear roles for follow-up, tracking, archiving, and escalation of investigations.

To find out how The App can help you better manage the problem of drug diversion, visit The Drug Diversion App from LogicStream Health™ page on our website, where you can request an online preview.

 

About the Author

Patrick developed a passion for innovation re-engineering bicycles to better suit the needs of childhood. He started his career in medical research, then as a Clinical Pharmacist and an Informatician. He developed experience leading innovative teams at Wolters Kluwer Health as the Vice President of Informatics and Clinical Development. There he spearheaded the creation of a solution that established the company as the recognized leader in the market within four years. He also led the informatics team at Hennepin County Medical Center before co-founding LogicStream Health.

Topics: Patient Safety, Drug Diversion

The Drug Diversion Epidemic – Part 3: Impact of Inaction

Posted by Patrick Yoder on Jan 2, 2020 3:55:14 PM

Part 1 of this drug diversion blog series focused on the ways healthcare workers gain access to and redirect controlled substances. Part 2 explored the actions hospitals are taking to address the problem. In this blog post, we’re taking a look at why some hospitals may be slow to act, and what happens when their response is delayed.

Drug diversion denial

Drug diversion has the potential to compromise patient safety by increasing the likelihood of tampered or diluted drugs will be administered to the patient. This could lead to increased risk of patients being exposed to infectious disease or experiencing inadequate sedation/analgesia. It also damages the lives of healthcare providers who are diverting medications and has a negative impact on hospital reputations. So why are some hospitals reluctant to take action?

According to a recent survey of more than 650 hospital executives and providers, many are in denial about substance use and drug diversion in their own hospitals. The study found that 26% of executives and 29% of providers mistakenly believe that substance use is less prevalent among hospital employees than in the general population. While 85% of providers are concerned about the problem of drug diversion and misuse – and 50% report observing suspicious behavior – less than 20% think drug diversion could be a significant problem at their facility.

Training is key

Although 60% of providers in the survey said they had participated in drug diversion training or discussed the problem at work, the remaining 40% reported having no formal training to help them recognize or address the issue. However, education is key to helping healthcare providers identify the warning signs of drug diversion and possible addiction. When healthcare workers are informed, they can report their observations and reports of suspicious behavior can be investigated by examining ALL the related data. This includes patterns of activity in the electronic health record (EHR) associated with medication ordering, dispensing, and administration as well as documentation of care provided. 

Significant impact

When healthcare organizations fail to train their employees and put in place adequate controls to prevent and report drug diversion, they can face serious legal, operational, and regulatory sanctions from the DEA, state and local authorities. Instead, healthcare organizations must put in place and enforce a comprehensive drug diversion management program that involves operations, compliance and internal audit functions. Effective diversion prevention programs should primarily focus on the movement of controlled substances through their facilities. However, they may need to expand scope to pay special attention to the use of high-cost medications and performance-enhancement medications to thoroughly assess possible diversion.

Given the absence of adequate monitoring and controls, drug diversion can occur and persist. Below are a few examples of healthcare organizations where diversion occurred and resulted in significant negative impacts for the healthcare system:

  • A medical center in Dallas failed to notify the federal Drug Enforcement Administration about missing painkillers, sedatives and other addictive drugs. Two of the hospital’s nurses died of overdoses and two other nurses were arrested for stealing drugs.
  • One hospital in Atlanta reported an estimated loss of more than one million doses of controlled substances, resulting in a three-year probation of its pharmacy license and a $200,000 fine from the Georgia Pharmacy Board.
  • A hospital in Massachusetts reported the theft of more than 16,000 pills and paid $2,300,000 to settle its case with the Department of Justice (DOJ) for failing to have appropriate controls in place to comply with the Controlled Substances Act.
  • A multi-state health system reported the theft of more than 20,000 pills and settled its case with DOJ for $1,550,000.

Technology solutions

Across the country, many healthcare systems are using technology solutions to track patterns that can uncover drug diversion. Analytical software tools can speed up the monitoring and detection process by allowing timely review of data. In Part 4 of this blog series, we’ll delve deeper into how hospitals are using technology to help prevent and detect drug diversion.

 

About the Author

Patrick developed a passion for innovation re-engineering bicycles to better suit the needs of childhood. He started his career in medical research, then as a Clinical Pharmacist and an Informatician. He developed experience leading innovative teams at Wolters Kluwer Health as the Vice President of Informatics and Clinical Development. There he spearheaded the creation of a solution that established the company as the recognized leader in the market within four years. He also led the informatics team at Hennepin County Medical Center before co-founding LogicStream Health.

Topics: Patient Safety, Drug Diversion

The Drug Diversion Epidemic – Part 2: How Hospitals are Taking Action

Posted by Patrick Yoder on Nov 21, 2019 11:30:00 AM

Part 1 of this drug diversion blog series focused on ways healthcare workers gain access to and redirect controlled substances. In part 2, we’re looking at what hospitals are doing about it.

Identifying risk

As discussed in part 1 of this series, substance abuse by healthcare providers can negatively impact patient care. This can result in patients not getting the medications they need. Clinicians diverting drugs for personal use pose an even higher risk to patient safety. Healthcare workers increase risk of infection to patients and are less able to provide high quality care in an impaired state.

Healthcare systems successfully addressing the drug diversion problem begin by identifying workers at the greatest risk for abusing and diverting drugs. Thorough screening of people during the hiring process is essential, including special attention paid to drug abuse risk factors identified by the U.S. Centers for Disease Control and Prevention. Targeted drug screening of existing employees, conducted in compliance with the health system’s drug screening policy in a transparent manner, also deters workers from diverting and inappropriately using drugs.

Training staff to recognize signs and symptoms of drug addiction is another important step. Creating a clear process that employees can use to report concerns anonymously can help health systems identify healthcare personnel who are exhibiting early signs of addiction.

Prevention

To prevent, detect and respond to drug diversion, health systems are putting comprehensive controlled substance diversion prevention programs in place. There are three basic steps that can be implemented to help prevent drug diversion, including:

  1. Limiting access to controlled substance storage areas
  2. Ensuring a separation of duties, such as pharmacy purchasing and receiving of controlled substances
  3. Requiring a witness for waste removal by nursing staff

IT safeguards can help, such as unique usernames and passwords for PCA pump key storage, ADS cabinets, and EHR systems. Close management of inventory control systems can also prevent unauthorized access. Video surveillance of areas that are considered high risk for diversion should also be part of any diversion prevention plan. These areas can include pharmacies, surgical suites, anesthesia areas and emergency departments.

Monitoring and detecting

Many hospitals are using technology solutions to track patterns that can uncover drug diversion. Analytical software tools speed up the monitoring and detection process by allowing timely review of data contained in electronic health records (EHRs) and dispensing systems. Historically, hospital diversion teams have had to painstakingly stitch together data from automated dispensing cabinets, the EHR, and employee time cards to get a complete picture of a potential diverter. Using technology solutions that allow for near real-time data analysis can rapidly speed the investigation process once diversion activity is suspected. Early detection using technology means you can find potential drug diverters sooner – before they do more harm to themselves, patients and, ultimately, to the health system’s reputation.

Confirming suspected diversion via the EHR and other systems

When a possible diversion problem is identified, it’s time to take a closer look at patterns of activity in the EHR, dispensing practices and charting activity. Diversion often occurs at the patient bedside through substitution or improper charting, making it difficult to detect. It’s important to pair the evidence gathered from the data with observation of behavioral indicators.

First, consider warning signs related to patient care. Does the healthcare worker regularly have patients who complain about pain that hasn't been alleviated or offer to medicate other nurses’ patients? Maybe they obtain larger doses of narcotics or frequently record whole vial wastes that were not witnessed? These could all be signs of drug diversion.

Then analyze the suspected diverter’s personal behavior. Do they have frequent, unexplained disappearances during their shift? Do they come to work on their days off (perhaps saying they need to retrieve forgotten items), or volunteer to work extra shifts? Do they often spill or waste narcotics? Are there changes in their behavior, such as deterioration in personal appearance, job performance, or increasing defensiveness or isolation from peers?

Addressing confirmed incidents

If these signs support the suspicion that drugs are being diverted, the next step is to conduct an interview and investigation. When incidents of narcotic diversion are confirmed, they must be reported to the U.S. Drug Enforcement Administration, state licensing boards and law enforcement agencies. Prompt and thorough reporting is necessary to avoid negative economic impacts and prevent continued diversion. Health systems often choose to offer a rehabilitation path to help diverters addicted to controlled substances recover. To deter relapses, hospitals must put vigilant monitoring in place for healthcare workers who are practicing on a limited license.

Taking the necessary steps to prevent and detect drug diversion is no small task. In Part 3 of this blog series, we’ll take a look at why some hospitals are slow to act, and the impact of an inadequate diversion detection program.

 

About the Author

Patrick developed a passion for innovation re-engineering bicycles to better suit the needs of childhood. He started his career in medical research, then as a Clinical Pharmacist and an Informatician. He developed experience leading innovative teams at Wolters Kluwer Health as the Vice President of Informatics and Clinical Development. There he spearheaded the creation of a solution that established the company as the recognized leader in the market within four years. He also led the informatics team at Hennepin County Medical Center before co-founding LogicStream Health.

Topics: Patient Safety, Drug Diversion

The Drug Diversion Epidemic – Part 1: Redirection of Controlled Substances

Posted by Patrick Yoder on Nov 1, 2019 11:59:24 AM

Approximately 10% of all healthcare workers will steal opioids and other substances from patients and hospitals at some time during their career, according to a national database that tracks drug diversion. This problem occurs across health systems of all sizes, all around the country. Fueled by the escalating crisis of opioid abuse, drug diversion has become a significant risk for healthcare organizations. The good news is automated software tools are playing an important role in prevention and detection. More on that later in this series. First, let’s look at the impacts, motivation and opportunities for diversion within the healthcare system.

Impact

Sometimes referred to as healthcare’s hidden epidemic, drug diversion is a multi-faceted problem that poses serious risks to patient safety. Drug diversion has led to infection outbreaks, caused patient suffering and resulted in deaths. For many health systems, failure to put effective controls in place has resulted in significant financial penalties, patient harm, and ultimately reputational damage.

Motivation

The types of drugs targeted for diversion vary depending upon whether healthcare workers are seeking drugs for their own use or to sell for profit. While opioids are the most commonly diverted drugs, they aren’t the only substance being misused in the healthcare setting. People who are diverting often begin with less potent Schedule III drugs and progress to stronger medications, including injectable narcotics. Workers intending to sell the diverted drugs are more likely to target brand-name oral medications with higher street value.

How drug diversion happens

In any medical system, many people have access to controlled substances. That group includes but is not limited to nurses, pharmacists, anesthesiologists and pharmacy technicians. Potential diverters include staff involved in procuring, preparing, dispensing, prescribing and administering drugs, as well as anyone disposing unused medications. At any of those points in the process medications can be diverted, and risk of drug diversion is heightened when the same person performs more than one of these functions:

  • Ordering – Procurement teams include people who order, receive and pay for controlled substances. If the hospital system is not routinely reviewing ordering patterns and comparing the amount of drug purchased to the amount dispensed, an opportunity for diversion is present.
  • Dispensing – Healthcare workers who prepare and dispense medications may pocket controlled substance vials or syringes substituting saline or some similar fluid for the actual drug.
  • Prescribing – In addition to doctors who write prescriptions for themselves, other healthcare workers may have access to prescription pads that can be used to forge prescriptions. Diverters may alter verbal orders to increase the amount prescribed.
  • Administering – Automated distribution devices are another potential point of access for healthcare workers intent on diverting drugs. For example, if use of automated distribution devices is not monitored, workers could withdraw medications on cabinet override for a patient who has already been transferred or discharged.
  • Disposing – Expired or excess medication should be disposed of in a specific manner and in some cases a witness is required when disposing in a secured container. When these practices are not followed, healthcare workers can remove medication from the disposal container, possibly replacing it with another substance to avoid detection.

Combating the problem

What can be done to combat this problem? The first step is to recognize the reality that diversion of desirable drugs, including controlled substances and high-cost medications, is taking place in most healthcare systems. Healthcare facilities need controls to identify and prevent drug diversion, and resolve instances when diversion is suspected to be occurring. Technology plays an important role in prevention and detection. The next blog in this series will examine steps hospitals are taking to clamp down the risk of drug diversion.

 

About the Author

Patrick developed a passion for innovation re-engineering bicycles to better suit the needs of childhood. He started his career in medical research, then as a Clinical Pharmacist and an Informatician. He developed experience leading innovative teams at Wolters Kluwer Health as the Vice President of Informatics and Clinical Development. There he spearheaded the creation of a solution that established the company as the recognized leader in the market within four years. He also led the informatics team at Hennepin County Medical Center before co-founding LogicStream Health.

Topics: Drug Diversion

Trending Topics for Healthcare Leaders

The LogicStreaming blog is most often authored by Patrick Yoder, Pharm.D. Patrick is CEO and co-founder of LogicStream Health and covers a variety of topics related to hospital and health system clinical process improvement opportunities. The LogicStreaming blog is here to educate and inform hospital and health system leaders on topics such as:

  • Drug Diversion
  • Drug Shortages
  • Drug Utilization
  • Nursing Documentation/Flowsheet Management
  • Clinical Process Improvement
  • Trends & Issues Affecting Healthcare Leadership & Clinicians
  • Innovations in Healthcare Information Technology
  • Healthcare Leadership
  • Healthcare Patient Safety & Quality

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