It’s a sad fact that our country continues to grapple with an opioid crisis and drug diversion remains a related, wide-spread side-effect of that crisis. In fact, experts estimate that 94% of diversion incidents involved opioids.
An astounding 47.2 million doses were lost to healthcare employee misuse and theft in 2018, according to the 2019 Drug Diversion Digest by Protenus, Inc. Despite these large numbers, most professionals believe this is just the tip of the iceberg.
“The diversion of drugs from health facilities is still vastly under-reported,” said Commander John Burke, president of Pharmaceutical Diversion Education, Inc.
The problems of drug diversion
Drug diversion impacts hospitals in a number of serious ways. First, patients are put at risk for sub-par treatment by impaired staff, or their treatments may be ineffective if they receive a partial dosage due to drug tampering. The diverting staff member faces the health risks of drug abuse, legal consequences, jail time, and fines, in addition to providing a lower quality of work. Finally, the organization itself risks delivering less-than-optimal patient care that results in fines, bad publicity, and loss of community trust.
Who is diverting narcotics?
The Protenus report found the vast majority of diverters work in hospitals (33%), medical practices (29%), long-term care facilities (17%), and pharmacies (16%).
The roles held by employees discovered to be diverting medications were:
- Doctor 37%
- Nurse 30%
- Employee 14%
- Pharmacist 10%
- Pharm tech 4%
The impact of these diversions amount to 20.9 million lost doses and fines of $30.1 million. Perhaps most alarming among these statistics is that the average time it takes a diverter to get caught is 17.8 months and the longest recorded event was 12 years.
How to mitigate diversion
Tackling drug diversion is hard work. It starts with a thorough review of your processes to identify weaknesses. To begin, ask yourself these questions:
- How many diversions have you identified in the last year?
- How much time do you spend reviewing diversion-related reports?
- Does your hospital have a diversion committee? Is it active?
- Have your diversion detection processes and approach been reviewed lately?
- Are you looking in the right areas?
Many hospital pharmacies look at discrepancy events, pulled vs. stocked reports, inventory counts, and conduct random patient audits. The problem with this approach is that it only scratches the surface. You need to dig deeper.
Diverters tend to be clever and find every loophole available. They also constantly adapt to process changes meant to discourage them. This means that to really tackle of diversion, your team must look at reports that detail:
- Null events
- User comparisons
- Dispensing by user type
- Ordering vs. utilization
- IV patient-specific waste
- Average activity by days worked
- Waste events
You can obtain these reports and others from automated dispensing cabinet (ADC) systems like Omnicell and Pyxis. These systems and other companies offer analytics programs that can help you perform a more detailed analysis quickly.
We recommend a daily review of the following:
- Narcotic vault exceptions
- Restock-destock matching
- Items removed and returned to pharmacy
- Waste, either too much or too little
- Post-case reconciliation for procedural areas
- Null transactions
In addition, each month you should review overall dispensing practices by user and compare user teams against others. You may need to create special reports as needed to look at specific transactions, drugs and control levels.
More steps you can take to stop diversion
Pay special attention to those staff members who report waste outside desired time ranges, have undocumented waste, whose behavior falls outside normal inventory processes, or who frequently appear on reports.
You should also make pharmacy more visible in the hospital by participating in rounds and getting out on the floor to talk face-to-face with staff, physicians, and leaders. Finally, cultivate an atmosphere conducive to open reporting to encourage people who see something to say something.
By Dana Fox, Pharm.D., Quality and Performance Improvement Manager at CompleteRx