Drug diversion is a real concern in the healthcare setting. It is estimated that 10% of nurses are dependent on some type of drug. Hospital staff are as vulnerable as the rest of the population to addiction. When you consider that vulnerability, and add to it the access healthcare providers have to the addictive medications, steps must be put in place to monitor for diversion. Allowing a healthcare provider to divert medications from the intended path (the patient) to themselves results in multiple points of risk.
Patient Risk
The primary victim of diversion is the patient. The risk to the patient can vary anywhere from being cared for by an impaired healthcare provider who is not at the top of his or her game, to being infected with contaminated drug supply which can lead to lifelong illness or permanent harm.
Hospital Risk
Healthcare facilities have an obligation to protect their patients. Facilities that don’t, risk legal and regulatory consequences as well as negative publicity and financial implications. All facilities must have a diversion program in place to monitor and respond if a diversion incident does take place. There are multiple state and federal agencies that enforce existing laws and regulations, and they will hold facilities accountable in the event of an incident. Regulatory agencies also survey with respect to accountability of controlled substances and will ask to see how a facility handles chain of custody and monitoring. Have you educated your staff to their obligation to report?
Healthcare Provider Risk
Let us not forget the healthcare provider. The staff work as a team and if there is an impaired team member it puts all members at risk. The member at the highest risk is the addict themselves. Having a solid monitoring program in place will help facilities identify signs of diversion and impairment sooner rather than later with the goal of getting help for the employee as soon as possible.
Our pharmacy consultants at Rxpert Solutions offer a comprehensive approach to diversion monitoring. We have years of experience in this area and can assist you in developing a program for your facility, assess risks within your current program, work with you to create solutions, aid in monitoring, and provide training and education.
I hired Terri (lead pharmacy consultant for Rxpert Solutions) to develop a controlled substance monitoring program for our 397 bed hospital. Terri performed a complete risk assessment of our practices and put a comprehensive program in place. It involved not only monthly audit reviews of nurse activity, but other monitoring practices within the pharmacy and on the nursing units. She worked well with nurse managers and educated them on what to look for and how to interpret the pharmacy generated audit results. She was a sounding board for them if they had concerns and they would often look to her for direction on next steps. Terri emphasized the need to report suspected diversion cases to the appropriate agencies including the Board of Nursing, and with her help, a process of reporting was implemented. Terri also recognized the need to get help for healthcare providers with addiction issues. She would train the nurse managers with this in mind and encourage them to take this approach with staff. She also gave regular education to staff and new nurse graduates on the risks of addiction, how to recognize it and how to get help if needed.
Prior to the implementation of this program, I was not aware of any staff at this facility being disciplined for suspected or confirmed diversion. Within the first month of implementation of the program, nurses were literally handing over their badge to their manager when confronted. In the first year of the program, 23 staff members had been terminated and reported for suspected diversion. This was no longer a facility that allowed a free for all with controlled substances. Terri helped us make it a safer place all around and the program continues with success.
Terri has a lot of experience and an instinct I learned to listen to when she thought something was “off”. She balances compassion, intolerance for diversion, safe patient care, and the ability to engage the team to find solutions that make a difference. I would highly recommend her for any hospital looking to start or improve their diversion program.
Victoria Hong, Pharm D
Director of Pharmacy
