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doses for patients who do not require a dose, but still documenting as an administered dose.


While ADCs effectively control access to medica- tions, many of these systems lack the comprehensive reporting functions to identify all possible methods of drug diversion. Most ADCs offer some reporting func- tions, but accessing and running the reports is often time consuming. The re- ports themselves are not always easy to navigate,


Ray Vrabel is senior director, medication systems strategy, Omnicell.


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and identifying diversion trends can be diffi cult. To address this concern, several companies are offering compatible software programs to run data reports on ADCs to monitor medication-usage pat- terns. The software helps identify potential diverters, building a safe and secure environment for patients. One of the leading medication-usage reporting tools is from Pandora Data Systems, which leverages hospitals’ existing ADCs and integrates the import process into the work fl ow. While tracking each pill that is dispensed, administered and returned to the ADC system, the new PandoraVIA solution is also able to receive drug administration from a hospital’s electronic medication administration record (eMAR) system to look specifi cally at dispensing and drug delivery discrepancies.


No hospital is immune to drug diversion, but there are proactive steps that can help detect diversion before it becomes an issue of patient safety.


For a drug-diversion prevention program, Pandora’s Anomalous Usage Reports, Discrepancy Reports and Activity Reports are effective tools that allow hospital staff to examine ADC activity trends. By accessing data from the ADC or using real-time HL7 interfaces from the ADC to Pandora, hospitals can run reports to show medication-usage trends for the entire hospital and iden- tify individuals with transaction anomalies worthy of fur- ther examination. The Pandora solution reduces the time spent on collecting data and generating reports, while allowing hospitals to more effectively identify potential diverters. Since the data is easily accessible, reporting tools also help improve the auditing effi ciency and meet the increasingly stringent regulatory compliance require- ments of The Joint Commission and the DEA.


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One study showed that drug diversion could be as high as 18 percent among nurses. However, diversion goes beyond nurses to include physicians, pharmacists and any other employee involved in handling controlled substances.


Case study: Prevention methods


In June 2009, a report of Boulder Community Hos- pital in Colorado made headlines when the hospital an- nounced 108 instances of theft and tampered fentanyl vials taken from automated dispensing equipment. The report indicated that a nurse had been replacing fentanyl with saline, often referred to as substitution of medica- tion, and the diversions potentially involved more than 350 patients over a one-month period. The investigation began when anesthesiologists became aware that surgi- cal patients did not appear to be receiving enough pain medication.


Unfortunately for hospitals and health facilities, it is only a matter of time before drug diversion will occur. If hospitals have a medication surveillance program, they may be able to detect diversions earlier, before patient safety is put at risk. One of the biggest barriers to stop- ping drug diversion is proper reporting tools implemented and used at the hospital. Prevention measures and proper reporting of drug diversion to authorities are critical to re- ducing drug diversions and protecting patients. HMT


HEALTH MANAGEMENT TECHNOLOGY December 2010 19


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