Identify drug diversion
Prevent theft and misuse
Our nation’s hospitals, pharmacies, and doctors’ offices are plagued with an opioid crisis and related drug diversion problem. Inconsistent procedures and medication oversights have enabled thousands of employees throughout the healthcare system to misuse millions of doses of controlled substances each year.
This problem is detrimental to patients, providers, and diverters, too. Care providers can face regulatory liability, fines, reputational damage, and profit loss if they neglect to monitor diversion issues. But the consequences for patients are even worse. Impact to patient care can include denial of pain relief, spread of bloodborne pathogens, and other patient harm, even death.
Opioid overdose deaths per day in 2018
Of all healthcare professionals will misuse substances during their lifetime
Estimated cost of diversion to medical insurers per year
From reactive to proactive
Drug diversion doesn’t happen in a vacuum. Often, things that start as policy violations or sloppy practices end as bigger problems. For instance, nurses could be failing to comply with an organization’s rules regarding medication waste. While this may not indicate diversion, it indicates an issue, nonetheless – and a risk.
Common drug diversion use cases
Early detection is key to minimizing the lasting impacts of drug diversion. Knowing the red flags to look for can help you quickly detect and respond to potential drug diversion incidents. Without the proper monitoring programs in place, it’s difficult to identify which incidents are the result of policy violations and sloppy practices and which incidents are drug diversion. Regardless, the longer they go unnoticed, the worse the effects are for all.
One way to identify potential diversion is with targeted diversion monitoring of inventory discrepancies. Every time a user accesses a controlled substance in a dispensing cabinet, he must complete an inventory count before removing it. An inventory discrepancy happens when the medication count in the cabinet is off, for example, there should be 20 vials, and the user enters a count of 18. If a discrepancy is noted, this can signal a policy violation, sloppy practices, or it can signal drug diversion.
Excessive waste quantity
Wasting more medication than one’s peers is another red flag. Watch for wasting entire quantities of a medication or withdrawing a larger unit than necessary. For example, a user withdraws a 10 ml vial to give a 3 ml dose, but the cabinet stocks 5 ml vials. When waste quantities are excessive, especially by one user, follow-up is needed. For example, find out how long it took for the user to waste it. Best practice is to waste medication at the time of dispensing. When a patient refuses medication or a nurse accidentally drops the vial on the way to the patient’s room, the user should waste the medication within an appropriate timeframe as established by policy.
High-risk department monitoring
Certain departments are considered high risk for drug diversion. Employees who work in these departments have easy access to the drugs most sought-after by diverters. Med-Surg units frequently administer medications and often experience the highest number of diversion incidents; however, other departments are also high risk. Hospice and Anesthesiology/OR departments dispense the most controlled substances, while Oncology departments dispense chemotherapy drugs, which have high street value.
Anomalous behavior detection
While less concrete than the other risk factors, anomalous behavior ‒ that is, one employee acting differently than their peers or their own previous behavior – is another red flag. Reviewing actions, such as dispensing controlled substances, wasting medications, and creating discrepancies can identify users exhibiting unusual behavior. Other, more specific examples to watch for include employees acting as frequent waste witnesses; dispensing medications on override more than others; and accessing high-risk medications more than others. These are all potential signals.
High-risk patient population monitoring
Like high-risk departments, certain patient populations are considered high risk for drug diversion. Employees who work with these patient populations have easy access to the drugs most sought-after by diverters. Any units where patients are on high doses of pain medications are considered high risk because it’s harder to notice a user who is dispensing more than his peers. Also, patients who are non-verbal are high risk because they aren’t able to communicate their pain levels or other information to indicate a problem.
Simultaneous station access
Compromised credentials can lead to drug diversion. Any instances of the same user logging on to two different workstations within minutes of each other warrants further investigation. Compromised security monitoring draws your attention to an employee who is simultaneously accessing multiple stations. This can be a red flag for a policy issue or sloppy practice, or drug diversion.
Users who are excessively accessing medications without orders and/or canceling transactions at the dispensing cabinet after the drawer of the dispensing cabinet has opened may be diverting drugs. Even if it is not diversion, it is a poor practice that should be minimized.