LogicStreaming Blog

There is good news and bad news regarding the drug diversion epidemic, a widespread and multi-faceted problem that poses serious risks to patients and healthcare systems alike. First, the bad news. The COVID-19 pandemic has exacerbated an already challenging situation, making it even more imperative for health systems to identify and mitigate drug diversion incidents.

Persisting COVID-19 challenges

Even as vaccination rates climb, the novel coronavirus and its continually evolving variants affect drug diversion risk in several ways. The waves of critically ill patients inundating hospitals have driven pharmacists to order larger-than-usual quantities of lifesaving drugs. Many of these are controlled substances, increasing the opportunity and temptation for drug diversion, especially given the many clinicians experiencing pandemic-related stress and trauma.

Also, pharmacists have been serving on the vaccination front lines, further limiting the time they can devote to ongoing diversion evaluation and monitoring.

The COVID-19 pressures add to the drug diversion management challenges health systems already face, including reliance on inefficient, time-consuming manual processes. Typically, these involve health systems periodically spot-checking approximately 10 to 20% of their total transactions every month, using 30-day old data.

Three key action opportunities

Now, for the good news. Here are three reasons to be hopeful that significant progress can be made toward reining in this epidemic:

1. New guidelines. Governing bodies such as the Joint Commission and the American Society of Health-System Pharmacists (ASHP) are developing new guidelines and standards to facilitate more effective diversion management. These new standards are expected to drive improvement in several ways, including:

   • Identifying 1,000 potential at-risk diversion points across a hospital, such as procurement, preparation and dispensing, prescribing, administration and waste removal. Encouraging hospitals to view drug diversion holistically across the clinical continuum will help prevent diversion as well as more quickly detect incidents.

   • Reviewing 100% of controlled substance transactions using data that is no more than 24 hours old.

   • Leveraging technology to automate the identification and investigation of drug diversion activities to accelerate the timeline and boost accuracy.

3. Updated protocols. Most health systems indicate they are planning to refine their drug diversion management structure, policies and procedures to integrate these emerging guidelines. Until recently, many C-suite executives have not been willing to proactively address the threats associated with the poor performance of their legacy processes. However, large fines from the DEA, negative fall-out from publicly reported diversion events and anticipation of the new guidelines emerging have now made improving drug diversion practices a top priority.
   
   It is encouraging to hear that approximately 60% of health systems have already created a drug diversion committee, and many systems plan to incorporate a dedicated drug diversion management role into their structure. However, there’s still room for improvement as staff priorities continue to compete for time.
   
   
4. Technology innovation. Automation, machine learning, artificial intelligence, radio-frequency identification (RFID) and other emerging technologies have the power to eclipse antiquated drug diversion processes. On average, it currently takes a hospital 22 months to detect a diverter. New technologies designed to improve the speed and accuracy of drug diversion identification can dramatically cut this delay. For example, The Drug Diversion App from LogicStream Health™ integrates information from electronic health records (EHR), automated dispensing systems (ADS), and time and attendance systems to deliver near real-time insights on drug diversion activities and individuals that may signal a cause for investigation. The software tool eliminates hours of tedious, manual work – accelerating investigation efficiency, accuracy and response time.

Changing the status quo

Current data suggests that more than 95% of diversion activity not only goes undetected – it goes uninvestigated. Health systems that have already deployed a fully automated system and begun reviewing 100% of their transactions are often stunned to see the discrepancies compared with their previously manual processes.

The ability to flag potential signs of diversion down to the individual level also allows health systems to support clinicians, pharmacists and other staff in need of help. They can get timely treatment which prevents behaviors from escalating and compromising their health, as well as that of the patients for whom they provide care.

At the end of the day, it is about people. The more we are able to care for caregivers, the more they can provide good care. Everyone benefits from improved drug diversion policies, processes and technologies. The time to act is NOW.

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.