Full Transparency Is the Key to Stopping Drug Diversion in Healthcare Settings
By Russ Nix, PSQH
Is drug diversion a problem in the healthcare setting where you work? Chances are the answer is yes—but you might not realize it yet.
Drug diversion costs the healthcare industry more than $70 billion per year, according to one estimate, and some researchers say as many as 10% of all medical professionals will divert drugs from their workplace at some point in their career. This means every adult patient in the United States has likely encountered a healthcare worker who has diverted drugs.
Outbreaks of healthcare-acquired infections that stem from employee drug diversion are becoming more common. Just last year, 12 patients who contracted hepatitis C in a Washington state hospital were linked to one nurse who diverted drugs, according to a CDC report. And it isn’t just patients who are affected. When two Dallas hospital nurses died of drug overdoses in 2017, hospital reports and medical examiner records suggested that the medications were diverted from within the hospital.
So why aren’t these types of incidents at the top of every healthcare leader’s radar?
One of the main reasons is a lack of transparency. We’re either unaware of the drug diversion happening under our noses—a 2017 Porter Research survey of healthcare workers reveals that many drug diversion incidents aren’t detected or reported—or we’re sweeping it under the rug, telling ourselves it isn’t a big problem.
Most healthcare organizations would benefit from better transparency—improving the visibility of medications as they move to their intended destination, and gaining a clearer understanding of the who, what, and why around diversion. The more transparency we have, the more successful we’ll be in stopping diversion and keeping patients safe.
Much of the discussion around transparency centers on data, and with good reason. Physicians need to know when a patient gets only half of her prescribed pain medications, or why the clinical supervisor has ordered certain drugs. Hiring managers, meanwhile, need to know the full employment history of the clinicians and technicians they hire—and be alerted to any discrepancies or red flags in a person’s career that could suggest a history of drug abuse.
With better data transparency practices, doctors, nurses, and other healthcare providers can see the movement of controlled substances like morphine or fentanyl to their intended destination.
More visibility into patient data also allows us to recognize patterns of behavior that are associated with diversion. For example, advanced analytics software can help sift through disparate sources of data—medical records, inventory, confidential reporting, automated dispensing cabinet data, etc.—to unearth trends or patterns associated with drug diversion. From there, we can take the appropriate actions to ensure patient and employee safety.
Beyond the data
As the Porter survey noted, more than one out of five (22%) of providers’ healthcare facilities lack an established diversion prevention program, inclusive of education and training initiatives. Most healthcare organizations ask workers to report anything suspicious that they “see.” But while the intentions are good, this approach is limited—and subjective. Not every healthcare worker who diverts drugs does so for personal use. Also, with self-reporting, there’s a risk of unconscious biases: Without proper education on what behaviors are associated with diversion, healthcare workers may have preconceived ideas of who diverts or uses drugs.
Better education and training go hand in hand with transparency. It starts when healthcare workers are hired via a thorough vetting process that looks deeply into employment history and out-of-state job records. Education—which should be mandatory—should be formalized with programs led by drug diversion experts or other stakeholders. Healthcare organizations should also consider developing comprehensive educational programs based on the best practices of institutions that have learned from their flaws.
Human resource policies may also need to be shaped around these best practices. Most importantly, policies should clearly explain the physical and behavioral signs of drug diversion and the safest way to report diversion to a clinical supervisor. Simultaneously, healthcare organizations should familiarize themselves with online reporting tools and federal and state legislative and/or licensing bodies, so they know exactly what to do when they detect a problem.
While increasing data transparency by leveraging new technologies, improving education, and boosting on-the-job training is not a silver bullet, it is a step toward increasing awareness. A comprehensive effort to improve transparency can help an organization get ahead and stay ahead of drug diversion, avoiding financial, compliance, and safety issues.
Russ Nix is founder and consultant at Aegis RX, LLC. He has over 20 years of investigations experience with 15 years of experience in criminal narcotics investigations. Nix serves on the advisory board for the Healthcare Diversion Network, a nonprofit association dedicated to preventing drug diversion.