Following a series of public punishments from the DEA for drug diversion at hospitals and health systems nationwide, it’s time to stop viewing drug diversion as an uncommon practice. Instead, hospital and health system leaders need to recognize that “Drug diversion can occur anywhere controlled substances are found and can be committed by anyone with access to these drugs,” says expert Kimberly New, JD, BSN, RN, Diversion Consultant and Educator.
Many tools can be used to catch drug diversion, from analytics solutions to collaborative care teams that perform checks on medication orders. However, diversion rates won’t truly decrease until there is an industry shift towards proactive prevention and surveillance. As New states, “The goal of healthcare facilities should be to take proper steps to prevent what they can, detect diversion quickly, and respond to any incident in an appropriate and timely manner.”
To reflect the prevalence of this problem, the Institute for Safe Medication Practices (ISMP) outlined the following tips to prevent drug diversion in the March issue of its ISMP Medication Safety Alert! Acute Care newsletter:
- Expect Diversion – Statistics show one in 10 healthcare workers will abuse drugs. Not hearing about it does not mean it isn’t occurring.
- Secure Controlled Substances – Secure any vials or medications before leaving a medication prep area to administer a dose. Leaving these medications out, even for a few minutes, puts them at risk for theft.
- Limit Controlled Substance Dosing – Health systems should prohibit drawing more than one dose of a controlled substance into a syringe. Not only does this reduce waste, but it prevents partial doses from being diverted.
- Use Locked Infusion Pumps – All controlled substance infusions should be secured in locked infusion pumps, with a required witness for any waste disposal once the infusion is removed.
- Secure Medications During and Between Procedures – All medications used in the OR, procedural areas, or anesthesia work areas should be secure during and between cases. Secure workstations give the flexibility these areas require in accessing meds quickly by using scanners while having other checks in place to ensure medication security.
- Require Staff to Verify Dispensing and Receipt of Controlled Substances – Some automated dispensing cabinets (ADCs) offer unique single dose administration to ensure proper delivery of controlled substances. However, if this technology is not available, both the person delivering and receiving the substances should co-sign the appropriate record.
- Track Activity of ADCs – When using an ADC for dispensing and storage of controlled substances, data available in the software should be tracked and reconciled regularly. Using pharmacy analytics programs for detecting diversion can greatly streamline this process.
- Know Wastage Guidelines – There are federal, state, tribal and local laws regarding pharmaceutical wastage. Providers should choose the most appropriate and secure container for disposal. Ensuring the openings on these containers are small can reduce diversion, according to the ISMP.
- Supplement with Video – If disposal bins with large openings must be used, install video cameras nearby and regularly observe these monitors.
- Use Additional Security Measures – Secure disposal containers to a wall or stationary equipment. Limit access to keys to replace these containers to a small number of staff.
No facility is completely immune from drug diversion; however taking preventive steps can greatly reduce the risk for healthcare facilities, providers and patients. More information about drug diversion, how to identify diverters and what hospitals should be doing can be found on Diversion Central.