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.