Drug diversion is certainly not a new issue in the U.S., but it is one that is growing in concern for hospitals and health systems throughout the country. Not only can drug diversion pose a significant threat to the wellbeing of your patients and staff members, but it can also be damaging to the financial and legal security of your organization.
To help work against this, here is a closer look at what exactly drug diversion is, the primary motivations behind it, and some steps health systems can take to proactively plan against it.
What is drug diversion?
Drug diversion is the theft or loss of drugs within a health system, often taking place at the hands of employees within that very system. It typically involves people stealing and taking controlled substances without a prescription, such as nurses with easy access to these drugs. Instead of giving the drugs to a patient, a nurse might take some home to use for themselves or to distribute to another.
Drug diversion can happen at any level of the health system, from operating rooms and clinics to hospital wards and pharmacies – really, anywhere within the health system where access to drugs and the opportunity to divert them exist in tandem.
Why does drug diversion happen?
Generally speaking, there are three things that must be happening at the same time in order for a person to divert drugs.
- First, there is access to controlled substances and an opportunity present to divert.
- Second, there is motivation either from internal (personal distress, physical pain, or drug dependency) or external (family needs, loss of income, or debt) stressors.
- Finally, there is some degree of rationalization that makes it okay for the person to divert drugs. Rationalization can grow out of employee discontent or the perception that the diversion will not be noticed.
We can’t always know what a person is feeling or thinking, so it is incumbent on organizations to have strong internal controls and drug security to reduce the opportunities to divert. The best intentions of health systems can be undermined when staff rely on trust as the number one strategy to prevent diversion.
While drug diversion has been an issue for years, the global pandemic has created new opportunities for diversion by increasing both the level of access to these drugs and the opportunity to divert them.
Why is drug diversion a problem?
Patients are harmed when they don’t receive the prescribed pain relief or receive medications that have been tampered with, leading to serious infections or death.
Caregivers are harmed by faulty judgement of impaired staff and providers, suffering loss of trust in coworkers and other negative emotions.
Hospitals are harmed by non-compliance with federal (CMS) or DEA regulations and potential loss of CMS certification.
Healthcare organizations are harmed by the loss of a good reputation when news of a diversion event hits the press and/or by the reality of class-action lawsuits by patients.
Multi-million-dollar civil penalties and multi-year agreements of DEA oversight following diversion events are expensive and disruptive.
As health systems grow larger, a single case of diversion could become a triggering event for extensive DEA investigations across multiple entities. If diversion happens in one hospital, the DEA is likely to look further, and the risks become even more significant. If you haven’t yet seen signs of drug diversion, it’s not because they don’t exist – it’s because you simply aren’t looking hard enough.
What should you do about drug diversion?
It is important to understand that drug diversion should be on the executive team’s radar. The responsibility to prevent, detect, and manage diversion does not fall entirely on the pharmacy department. Many assume it falls on the shoulders of pharmacy because they have the drugs, but the reality is pharmacy can only control what happens within its own department. There are so many other people touching these controlled substances.
People that manage security, nurses, the HR department, and more all have a role to play – and none of these groups fall under pharmacy. This is why you need a governance structure in place that includes everyone working together – not in silos – to combat drug diversion.
How Visante can help
Visante recommends and can help you to implement four key strategies to manage drug diversion.
- Diversion program structure – A governance committee chaired by leaders, including the DEA registrant, to facilitate interdepartmental collaboration and support for diversion prevention, monitoring, and event management.
- Dedicated diversion resources – A dedicated diversion specialist who can manage analytics, coordinate with a response team, and determine the root causes and solutions when diversion occurs. This is more effective than assigning these duties out to multiple people with several other responsibilities.
- Diversion analytics – Software that merges information from pharmacy, medical records, and more, creating information to show you what staff are doing more effectively than relying on manual audits.
- Diversion playbook – Don’t wait for the next diversion to decide how to manage it. Have a playbook and plan in place for when diversion occurs and how you should respond. The plan should include how to investigate, interview, and intercede on behalf of the individual.
Visante takes a multi-disciplinary approach to diversion management to see how people interact with controlled substances across the entire health system. We have an advantage in understanding how the work happens, how the drugs are prepared and used, and where the risk points lie.
Contact us today to learn more about successfully working against drug diversion within your health system.