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:
- Limiting access to controlled substance storage areas
- Ensuring a separation of duties, such as pharmacy purchasing and receiving of controlled substances
- 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.
