The issue of drug diversion in healthcare is a major problem, with considerable consequences. What many may not know, is how prevalent this problem is and what impact the pandemic may have on it. Drug diversion puts the patient, the diverting employee, and the facility, at risk for harm and financial losses. It is speculated that many cases of stolen controlled substances either go undetected or unreported.
News sources readily report local and international drug diversion cases that caused injury, death, lawsuits, and regulatory fines. For example, a Texas hospital was recently fined $4.5M for lack of oversight after 2 nurses died from Fentanyl overdoses. Another hospital, this one in Michigan, was fined nearly $7.8M last year to resolve allegations that they violated certain provisions of the Controlled Substances Act.
For those who may not be familiar with the issue of how substances are being diverted away from the patient, we’ve answered some common questions, below, that we hear from our customers. If you have others in your organization who may not know all of the facts about how controlled substances are being diverted from the patient, feel free to share this blog.
Q: What does the term drug diversion mean?
A: In a healthcare setting, drug diversion is defined as medication that is redirected from its intended destination for personal use, sale, or distribution to others by means of theft, use, or tampering.
Q: How often are controlled substances stolen?
A: Drug diversion may occur in any healthcare setting that administers controlled substances to patients including, but not limited to, hospitals, inpatient rehab, skilled nursing facilities, nursing homes, hospice facilities, outpatient surgical centers, pain clinics, and emergency care facilities.
According to the ASHP (American Society of Health-System Pharmacists), Diversion of controlled substances is common. Unfortunately, it often goes undetected and is not discussed until events get publicized. Some recent high-profile events are raising new awareness of the prevalence of this issue and its implications. It is estimated that approximately 10% of healthcare workers misuse alcohol or drugs at some point in their careers, like the general population. Anesthesia staff is higher at 12-14%. The difference is that medical professionals are more likely to abuse prescription drugs. With the accessibility of controlled substances in the workplace, organizations must routinely evaluate their employees, systems, and patient care environments.
Q: Who are the typical people responsible for diverting drugs from the patient?
A: Any personnel that has access to the facility’s controlled substances COULD potentially steal medication. Typically, these are nurses and nurse anesthetists, anesthesiologists, surgical technicians, physicians, pharmacists, pharmacy technicians, and radiology technicians.
Q: When and how are the substances typically stolen from a hospital?
A: The drugs may be stolen in a facility at any point within the supply chain. A few examples are: during delivery from the medicine supply vendor to the pharmacy, during pharmacy vault inventory, when automated dispensing cabinets (ADCs) are restocked, during medication retrieval, returns and wastes in ADCs, and in procedural prep areas before the patient arrives. Although you may visualize most cases as simply theft, drugs can also be diverted by under-dosing patients, creating false verbal orders, taking PRN medications from patients or pulling duplicate doses, failing to waste or document waste, stealing from waste or sharps containers, substitution (replacing controlled substances with another product such as saline), and stolen prescription pads.
Q. How can we figure out if drug diversion is occurring at our hospital? Aside from learning when it’s happening, are there ways to prevent it from happening before drug theft occurs?
A: The first step to monitoring for, and preventing these incidents is to consider implementing a holistic diversion prevention program. The program must have the support of the administration and spell out clear policies and procedures to address the full spectrum of handling controlled substances and addressing potential or actual diversion events.
Typically, a program like this consists of a Diversion Manager or a Diversion team. The team would also contain a Diversion Manager or Specialist and include members from human resources, employee health, pharmacy, nursing, risk management, security, and other departments such as anesthesiology. Activities include monitoring and responding to potential diversion events, staff education, surveillance rounds, and support for the recovering healthcare worker that returns to work after an intervention program.
As part of the program, your hospital will want to have the ability to identify and collect corroborating data surrounding suspicious medication activity and trends.
You’ll want to monitor for metrics such as:
- Was the medication dispensed during the user’s (or witness user’s) scheduled shift?
- Was it dispensed in the location the user (or witness user) was scheduled to work?
- Did the user take out multiple doses or medications in a short period?
- Do the patient’s pain scores trend differently for this user when compared with peers?
- Was the maximum dose dispensed but not administered? If not, or a partial dose was administered, was a return or waste recorded?
- Has the user had other suspicious medication events?
While manual monitoring of the data, listed above, would be incredibly time-consuming and difficult, there are now software solutions that are able to monitor and alert for suspicious behavior. By purchasing software, such as DetectRx™, your hospital is able to analyze all controlled substance medication activities from dispensing cabinets, EMR documentation, and user timecard data.
Q: Can a caregiver stop this problem from happening?
A: Yes, a caregiver at the bedside can be attentive to the medication process or be proactive and inquire as to the proper process. If a caregiver identifies a deviation in the normal process, then he or she has the right to stop the nurse from proceeding. For example, the caregiver sees that medications are typically opened in front of the patient, including injectables that are opened and drawn up. When a nurse brings medication already opened and in a pill cup or in a syringe, it’s a red flag. Another example, if nurses are all scanning the patient armband and a medication they are about to give and the caregiver sees a nurse that is about to administer medication without performing the barcode scans, that’s another red flag. The caregiver has a right to question the activity and report it to the charge nurse or supervisor.
Q: Is there an easy way to report potential instances of stolen medications?
A: Unless your hospital has set up a diversion tip hotline, any employee that witnesses potential diversion activity or an employee that is acting suspiciously or impaired, should report it to the supervisor of the healthcare worker in question. If that supervisor is unavailable or you are not sure who it is, report it to the Diversion Manager or your supervisor.
With the prevalence of drug diversion still being a problem in hospitals, having ways to mitigate your risks can go a long way. You can contact us at firstname.lastname@example.org if you’d like to learn more about DetectRxTM or our other clinical/EHR solutions that can help support you and your hospital.
U.S. attorneys Andrew Birge and Matthew Schneider announce record-setting drug diversion civil penalty settlement with McLaren Health Care Corporation. The United States Department of Justice. (2021, January 20)