Drug diversion is an increasingly serious issue that tends to be substantially underestimated. In every instance, a potential threat to patient safety is present. This includes the risk of inadequate pain relief, exposure to infectious diseases through contaminated needles or drugs, and risks associated with unsafe care from impaired healthcare workers. Drug diversion can also pose risks to staff safety and regulatory compliance, as can be seen across all types of healthcare facilities and, across all clinical disciplines. Healthcare organizations face financial penalties, potentially in the millions, for lack of compliance with DEA regulations leading to diversion within their hospitals. Healthcare workers who divert for their own use risk addiction, overdose, death, loss of professional license, criminal prosecution, and civil malpractice suits. While the fallout of undetected drug diversion can be far-reaching and life-threatening, many drug diversion cases are undetected.
A recent report shows that about 8% of controlled substance transactions in U.S. hospitals using ControlCheck have a variance between the dispense and final disposition of the drug (i.e. administration, waste, or return). These variances could be indicative of drug diversion, yet only about half of those variances are ever investigated. Often, cases will go uninvestigated due to lack of time or priority. Inefficient auditing processes and a lack of comprehensive analytic workflows are common reasons why variances are often uninvestigated.
Experiencing Drug Diversion Firsthand
Before next-generation diversion technology started making its way onto the main stage, I led the regional diversion program at a large integrated delivery network. Our team developed key performance indicators to assess the effectiveness of our program, implemented a Controlled Substance Diversion Prevention Committee, formalized a Diversion Response Team, and evaluated next-generation diversion technology solutions.
Lacking next-generation drug diversion software, we used manual tracking systems and knowledge of drug dispensing processes to run reports on drug usage and dispensing patterns. Analytic reports were based on users per drug per automated dispensing cabinet and would only show a spike or abnormality in dispensing patterns but failed to account for why. These reports did not assess administration patterns or take into account common variances such as an increased number of shifts, waste patterns, an added hospice patient, or an actual case of drug diversion.
In instances where documentation practices or controlled substance usage patterns suggested possible diversion, the pharmacy quality and audit teams were forced to compare all data points manually to determine if there was an actual risk of diversion.
Some of these audits would simply reveal poor practice in dispensing or administration procedures, while others would reveal the need for further investigation. An audit of a possible instance of diversion would take more than four hours of chart reviews, making it virtually impossible to track every suspicious instance from start to finish effectively. Tracking documentation of all aspects of an investigation was also cumbersome and very manual without a system that allowed for multidisciplinary collaboration in one platform.
The need arose for a more effective technology solution to help prevent, detect, and respond to diversion. I advocated for our health system to review technology incorporating artificial intelligence and prescriptive analytics to take our diversion program to the next level. Emerging next-generation technologies provided us with an opportunity to adopt a comprehensive diversion solution that provided closed-loop visibility into medication transactions, an unbiased approach to risk scoring, and supported collaborative workflows during investigations.
The Role of Technology in Diversion Detection and Prevention
The introduction of next-generation software with closed-loop reconciliation and prescriptive analytics that we see today solved several of the issues that manual audits and standard deviation-based reports missed. Transactional level data and analytics revealed workarounds in the medication use process that put patient and staff safety at risk. Software that automates tracking controlled substances from the dispense to the final disposition of the drug in hospitals enables a diversion prevention team to better identify unaccounted-for medications and workarounds that impact patient safety and focus their time on investigating users at risk of diverting.
Advocating for Next-Generation Diversion Technology
As diversion technology continues to evolve and national guidelines are updated, hospital leaders should lean into adopting and optimizing the use of these software solutions to protect patients and healthcare workers. As leaders, we have an obligation to protect not only the patients in our care but our fellow healthcare workers who may be suffering from addiction. Healthcare workers who divert will circumvent all processes to maintain their addiction. It ceases to become solely a logistical and economic problem and evolves into a human, empathetic issue. While technology provides data-driven analytics to identify drug diversion, diversion prevention teams have the opportunity to provide compassionate support in helping diverters receive treatment. A collaborative approach, between different departments and agencies, is necessary to identify that a person is diverting and get them to help if needed. Next-generation diversion software ultimately allows teams to collaborate across departments and create processes that yield faster, more efficient, and more accurate results.
Healthcare workers should champion the change they want to see in hospitals, and technology and software are often the tools for implementing that change. For those who work in hospitals and potentially encounter diversion, it can make a world of difference to implement a technology that can help prevent, detect, and respond to diversion. A solution that supports collaborative, multidisciplinary workflows can streamline and expedite the processes required to confirm diversion and support the hospital in taking action. Staff who frequently complete time-consuming audits lose valuable time that could be spent treating patients. They should advocate for diversion detection technology to improve the safety of patients and fellow healthcare workers. It is exciting to see where this new intersection of healthcare and technology will take us and the continued impact it will have on patients, health systems, and healthcare workers.
About Sandy Still, PharmD
Sandy Still is an experienced pharmacy leader with experience in health system pharmacy. Prior to joining BluesightⓇ, Sandy was the Manager of Medication Safety, Use and Policy at the Medical University of South Carolina in Charleston, SC. During her time at MUSC, she helped implement ControlCheck. Prior to MUSC, Sandy was the Inpatient Pharmacy Quality Coordinator at Kaiser Permanente Northwest (KPNW) in Portland, Oregon. She developed KPNW’s controlled substances diversion prevention committee and co-led the Bluesight RFID implementation in anesthesia automated dispensing machines. Sandy has a passion for medication safety and believes that the Bluesight solutions are key to preventing medication errors, providing insight into medication management data, and allowing more time for pharmacy staff to focus on patients.