Drug Diversion Software Comparison

The use of automation in detecting drug diversion is an exciting new area. As one who has developed diversion programs at institutions and been responsible for overseeing the audit process, I know all too well how time intensive and demanding the process can be. It takes days per investigation when a deep dive is needed. The proactive monthly audits can take weeks, depending on the size of the facility. Additionally, performing a thorough audit and knowing what to audit takes skills, which one develops over time. The staff member performing the audit must have a certain aptitude for it, and ideally, a mentor who can work with them on what to look for and how to look for it. Not many facilities have a Human Resources Department (HR) that will allow administration of a Myers Briggs type test to determine aptitude, and most don’t have the luxury of having a skilled investigator to come alongside a new investigator to mentor them. The value of the diversion audits are dependent on time and skill. As a consequence, facilities do the best they can and largely depend on front line staff to make them aware of a potential problem and a need for a deeper investigation. 

With automation, those days are over! The automation in still in its early stages, so we need to be patient and willing to work for that automation. This article will review the various drug diversion software products. Vendor, as well as client, interviews have been performed for FairWarning, HelioMetrics, Invistics’ Flowlytics, Kit Check’s BlueSight, Omnicell Analytics and Protenus. BD HealthSight declined to participate. The results of those interviews are in the tables below. I do not have firsthand knowledge of all the products other than seeing demos. I originally planned to ask each vendor how many risk points their product takes into consideration, but I found the answer to that was not decisive enough to put in the comparison. Each product takes hundreds of data points into consideration when running the analytics, and the number of points looked at are increasing all the time as more data history becomes available.

There are four main points I would like to emphasize. First, a vendor may say their product can or does perform in a particular area; however, having the capability is different than a proven track record. Consider asking them specifically how many current customers are live in that particular area of coverage. You may find that the data can be extracted, but currently they do not have enough historical data for the artificial intelligence to make conclusions. Therefore, that area of coverage has not truly gone live. It will come in time, but understand what is possible now versus down the line (short term and long term). Along these lines, remember that your facility will only get the benefit of a feature if there is a way to get the data to the software monitoring system. For example, if you expect infusion pump data integration but your nursing staff bolus out of pumps, chart in various locations within the Electronic Medical Record (EMR), or chart on paper flow sheets, you will most likely be frustrated. Though infusion pump integration was listed as offered, your facility won’t be in a position to utilize it. 

My second point is related to the first. Since these drug diversion software monitoring systems are still in early states, there most likely will be growing pains with your vendor. They may be in the infancy stage with a particular coverage area, and they will learn from you. They may not have encountered all the data feed sources for a particular EMR or Automated Dispensing Machine (ADM), so installation may be delayed. If you currently have a home-grown or manual drug diversion monitoring system, you may have to adjust to looking at data or visual reports differently. This may lead to the vendor modifying or developing new types of reports for you. This is a good thing because you have a vendor who will work with you. It can also lead to some frustration, because it will require time and patience while working through the process of improvement.

Third, each of these drug diversion monitoring software programs require feedback from the facilities to improve the analytics and move toward more accurate alerts. It is extremely important that all staff involved in responding to the alerts are consistent in the feedback they provide to the software. For example, let’s say the software sends an alert for a healthcare worker (HCW) who has missing waste. The investigator does a deeper dive and the HCW states that they inadvertently threw the waste away without logging the waste in the ADM. Does the investigator provide feedback to the software that it identified a true positive (possible diversion or poor practice issue), or does the investigator provide feedback that it was a false positive because the HCW stated they actually did waste it so this is just a documentation matter? The feedback will be determined by the investigator and if multiple people are involved in investigations, then the feedback may be inconsistent. Definitions need to be clearly defined from the onset because remember, in order to decrease the false negatives or false positives, the analytics need to get “smarter.” The only way to do that is with consistent, accurate feedback. For the above example, the correct feedback is the software identified a true positive. The HCW may have indeed neglected to document waste in the ADM, but the fact remains the software correctly detected a missing item and you want the software to keep letting you know when situations like these arise. 

My fourth and final point for consideration is having one of these drug diversion software programs does not preclude the facility from having a designated person with oversight to the diversion program. These software programs will generate alerts, but someone needs to devote the time to review the alerts, investigate the details, pull in the Risk, Quality, and HR departments as well as unit managers. This person will also need to respond to any call to action which may be needed, whether that means working toward improved practice, or reporting suspected diversion. Also, there is more to a diversion program that happens outside of the diversion monitoring software. Policies and procedures need to be solid and in place for chain of custody. Gaps in drug security should be evaluated regularly, and continuous improvements made. There is a need for continually educating staff on the topic of diversion and their responsibility to report anything suspicious. Hospital leadership should be kept informed of metrics surrounding diversion. Facilities that have a designated drug diversion point person have more successful programs and less risk to their facility, staff and patients. 

In conclusion, there is extreme value in the drug diversion monitoring tools. The tables below will give you an overview and a place to start with your review. Consider costs in both directions: the cost of purchasing a software package versus the cost of not purchasing a software package. The cost to purchase is more straightforward. However, the cost of not purchasing, or worse yet, not having a drug diversion program of any kind, may in the end be a much higher cost, not only in dollars but in human life.

Vendor Table (for cells with numbers 1-7, see description below)

Client Review Table

Terri Vidals is Founder of RXpert Solutions, a drug diversion consultancy firm committed to patient safety and minimizing diversion risk for hospitals and healthcare facilities. For more information visit https://www.rxpert.solutions/