Drug diversion: taking action | Cardinal Health Insider

Drug diversion: taking action

Table of contents
Advance preparation
Investigative process
State regulations
Federal regulations
Confrontation
Staff communication
Conclusion

Drug diversion in healthcare is a very sensitive issue. No one wants to be in the situation where an employee, potentially a noteworthy employee, is suspected of putting the patients, the hospital and themselves at risk by diverting drugs. However, as highlighted in our first article, drug diversion is present and common and it is likely that you may be faced with dealing with a diversion situation in your career. This article, the last in our Insider series on drug diversion, outlines points to consider in preparing for and dealing with an incidence of diversion.

Advance preparation

Insider survey results
Last issue, we asked Insiders how often and from which Pyxis^® products do you run our top recommended reports for monitoring diversion.

View the most common reports

In order to ensure that all suspected employees are treated the same and communication to co-workers is consistent, it is essential to develop your policies and procedures for handling a case of diversion long before it actually occurs. A well defined policy minimizes the potential for confusion and procrastination if it becomes necessary to take action on a suspected incidence of diversion. Unfortunately, a delay in investigating the incident or confronting the individual can jeopardize patient safety, increase liability for the hospital and decrease the chance of recovery for the impaired healthcare worker. Therefore, planning ahead is critical to facilitating the intervention process.

The plan should include a detailed outline that encompasses the necessary actions and appropriate timeline for the investigative process, involvement of a defined multidisciplinary team, regulatory reporting, confrontation of the suspected employee and communication to the staff. The following are points to consider when defining your plan:

Investigative process

Insider series on drug diversion

Policies to prevent diversion
Monitoring diversion using Pyxis^® products

After running the appropriate reports as detailed in the 2nd article of this series, it is important to investigate further to determine whether there is a logical explanation for the activity or whether an incidence of diversion has occurred. As part of the investigative process, consider the following steps:

For a nurse:

Talk to the employee’s manager or supervisor
Review the medication administration records for any patient(s) the nurse may have cared for during the potential incident
Interview the patient(s) if necessary

For an anesthesiologist:

Talk to the chief of anesthesiology and the director of the OR
Review anesthesia records

For a pharmacy technician or pharmacist:

Talk to the employee’s manager or supervisor
If necessary, compare work schedules, DEA forms and invoices to the reports you have run

Assemble a multidisciplinary team

“Our Clinical Practice Panel relies on the information generated from Pyxis technology to proactively monitor and investigate potential cases of drug diversion.”

Ken LeBoutillier, Pharm. D
Director of Pharmacy
Sarasota Memorial Healthcare System

Upon completion of the investigation, you have determined the evidence is compelling enough to proceed. What is your next step? Before confronting an employee, you will need to assemble and meet with a multidisciplinary team. Each team member offers a different area of expertise. The consensus decision of the team will prevent hasty accusations and potential legal ramifications or push the investigation forward even if one or two members are reticent about the confrontation. Recommended members would include representatives from:

Employee supervisor
Human resources
Employee health
Security
Potentially risk management. Risk management should definitely be involved if there is any indication that patient care has been impacted.

State regulations
If an individual is found to be diverting controlled substances, reports have to be filed with the appropriate state board (i.e., pharmacy, nursing, medical).
Requirements for reporting to state authorities vary. Check with your state Board of Pharmacy and Nursing for reporting requirements.

State Boards of Pharmacy may be found at the link www.nabp.net.
State Boards of Nursing can be found at www.ncsbn.org.

Federal regulations
Federal regulations require that all thefts and any significant losses must be reported to the DEA immediately upon discovery of the theft or loss. Notification must be accomplished by completing and filing a DEA Form 106, Report of Loss or Theft. The form my be found on the Internet at www.deadiversion.usdoj.gov or may be obtained from your local DEA office. If the circumstances regarding the theft or loss need clarification before the form can be completed, the registrant can make an initial report via telephone or some other means and file the completed form as soon as the circumstances are known.

The confrontation
Confronting an employee suspected of diverting controlled substances is never easy. If your policy addresses the following questions, you will have a roadmap for proceeding with consistency and confidence.

Multidisciplinary team considerations:

Will the evidence be presented to the multidisciplinary team for evaluation prior to the confrontation?
What is the course of action if the entire multidisciplinary team is not in agreement with the conclusion? (e.g. the nurse manager refuses to believe the compelling evidence because it concerns one of the hardest working nurses in the unit)
How quickly will the multidisciplinary team meeting occur after compelling evidence has been gathered? (e.g. 1 hour, 1 day, etc.)
Which members of the multidisciplinary team will be involved in the confrontation and who will lead the discussion during the confrontation?

Confrontation considerations:

How quickly will the confrontation occur after compelling evidence is gathered or the multidisciplinary team agrees to proceed?
Where will the intervention be conducted to protect the individual’s privacy?
Will the individual be asked to submit to a drug screen?
Under what circumstances will the individual be placed on leave? Terminated? Eligible for rehire?
Will the individual be referred to drug rehab?

Communicating to the rest of the staff
Knowing what to say to the rest of the staff can be almost as difficult as the confrontation. Employee morale can suffer if this is mishandled. There is also the possibility of legal ramifications. The following questions should be considered when developing your plan for employee communication:

Will you involve Human Resources in employee communication?
How much detail can be communicated to the team?

Will Human Resources give an overview of the diversion?
Will the department manager give a high level update that there has been an issue?

Will there be any psychological assistance available for those having trouble handling the issue?

Conclusion to the Insider series on drug diversion
The facts indicate that diversion of controlled substances is occurring in our hospitals. We can not make it go away by denial, procrastination or lack of staffing to conduct investigations. We have a moral and legal obligation to our patients to protect them from impaired healthcare workers. We also have an obligation to our co-workers to get them the help they need. The earlier the intervention occurs, the better their chances of recovery. It is our hope that you will use this three part series on prevention, monitoring and intervention to develop an effective program for addressing the diversion of controlled substances in your hospital.

Insider survey results
Last issue, we asked Insiders how often and from which Pyxis^® products do you run our top recommended reports for monitoring diversion. View survey

% of respondents	Report	Generated form	Most common frequency
80.0%	Override report	Pyxis^® MedStation™ system	Daily
75.0%	C^IISafe Compare report	Pyxis^® C^IISafe™ system	Daily
73.0%	Proactive diversion report	Pyxis^® C^IISafe™ system	Monthly
67.5%	User Modification Report	Pyxis^® MedStation™ system	Daily
45.0%	Discrepancy report	Pyxis^® Reporter system	Daily