The incidence of drug diversion in the hospital setting – the illegal redirection of regulated medications for personal use or sale – is on the rise. In fact, it is no longer a question of “if” diversion will occur in your facility. It is a question of “when.”

Diverters primarily focus on three classes of medications: controlled substances, e.g. fentanyl, hydrocodone, oxycodone, methadone and hydromorphone; controlled chemicals, e.g. ephedrine and pseudoephedrine; and, expensive medications, such as LYRICA®, Soma and various oncology drugs. The typical timeframe to catch a diverter is roughly a year and a half.  

When diversion occurs, the impact can ripple across an organization. To start, patients may be denied pain management. Their safety and welfare may be compromised, and they may be charged inappropriately for medications they did not receive. In the bigger picture, hospitals are well-served to recognize and address the diversion crisis through improved protocols. Doing so directly supports the hospital’s mission of improving patients’ well-being.   

A hospital that fails to prevent the diversion of controlled substances may expose the organization to unnecessary risks and liabilities. Prior settlements against some hospitals have totaled in the millions of dollars.

“Having adequate controls and policies in place – and well-planned out – prior to the diversion happening is key, because it’s going to happen in every organization,” said Joyce Thomas, PharmD, associate principal, pharmacy advisory solutions for Vizient.

Building a drug-diversion prevention infrastructure

Combatting drug diversion requires committing to monitoring usage data; educating staff on how to recognize signs of diversion; implementing clear, zero-tolerance policies; and being prepared to take action immediately when diversion is detected.

A leading practice is to establish an organizational steering committee, which often includes representation from human resources, senior leadership, risk management, security, communications, pharmacy, nursing and anesthesia.

Thomas noted several additional recommendations for diversion detection and prevention.

  • Educate all patient-contact staff about policies related to drug diversion and its consequences. This is the first line of defense. Education and a zero-tolerance policy put all potential diverters on notice that it is being taken seriously by the organization.
  • Establish a culture of “see something, say something” to identify diversion in a timely manner. All staff members who handle controlled substances must be expected and empowered to speak up when something seems out of the ordinary. Senior leadership must support this culture and commend those who come forward to let them know that their contributions are important to patient safety.
  • Assign a diversion specialist with a clinical background. This is central to success because diversion prevention, detection and reporting must be handled uniformly. All levels of management should visibly support the actions of the specialist and anti-diversion team.
  • Identify who is responsible for monitoring the transactions of controlled substances. This person or group also should be aware of how diversion may occur.
  • Audit purchases against inventories; using automated vaults and distribution technology, and utilizing controlled-substance diversion surveillance software are all strong tactical approaches.
  • Monitor drug-wasting processes and install waste receptacles that deactivate or render the product unrecoverable and unusable.
  • Consult with representatives from your organization’s human resources, legal and risk management teams prior to interviewing a suspected diverter. It is paramount that interview techniques be consistent and presented by formally trained investigators.

The role of senior leadership in an effective diversion policy cannot be overstated. They must set a zero-tolerance policy and then follow through on enforcement.

“Implementing a new diversion program or revising an existing one offers a hospital an opportunity to communicate its commitment to solving the crisis,” Thomas said. “Every patient, every employee, every provider deserves the best from a hospital. This is possible with widespread education and deliberate action.”

For more information about how Vizient pharmacy experts can help minimize the drug diversion risk in your organization, click here.

Published: November 30, 2017