As reported by The Joint Commission (TJC), statistics from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Nurses Association (ANA) indicate that “about 10% of healthcare workers are abusing drugs” such as opioids (including fentanyl), depressants, hallucinogens, stimulants and anabolic steroids. In many cases, healthcare workers – “across all levels of an organization, from chiefs to frontline staff” – divert these drugs from their place of employment, creating threats to patient safety, putting employee health and safety at risk and potentially damaging the organization’s reputation and financial well-being.
In a recent “Quick Safety” publication, TJC warns organizations that “experts believe only a fraction of those who are diverting drugs are ever caught, despite clear signals — such as abnormal behaviors, altered physical appearance and poor job performance.” To strengthen safeguards against drug diversion, TJC recommends both building an organizational culture that empowers staff to “stop, question and act” and monitoring specific patterns and trends. It summarizes these efforts in the following three-pronged approach:
- Prevention: “Health care facilities are required to have systems in place to guard against theft and diversion of controlled substances. It is important that all staff understand and comply with these protocols, and act in ways to minimize unauthorized access or opportunities for tampering and misuse.”
- Detection: “Even with such prevention safeguards, health care facilities must have systems to facilitate early detection. These systems can include video monitoring of high-risk areas, active monitoring of pharmacy and dispensing record data, as well as having staff who are aware of and alert for behaviors and other signs of potential diversion activity.”
- Response: “At the institutional level, appropriate responses include establishing a just culture in which reporting drug diversion is encouraged, assessing harm to patients, consulting with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies.” TJC reminds organizations that there are also regulatory requirements for reporting drug diversion to entities like the DEA, law enforcement and licensing boards.
Describing past mistakes and missteps of hospitals and other healthcare facilities, Healthcare Executive has published an article with a number of “teachable moments” related to drug diversion, which it says can result in “hefty fines, lawsuits and revenue loss.” From those organizations that have, as Healthcare Executive says, “learned the hard way,” the article’s authors conclude that there are two main lessons:
- Consistently follow your anti-diversion policies.
- Provide effective controls from automated drug-dispensing machines.