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Drug Information Systems

Identifying and dealing with drug diversion

How hospitals can stay one step ahead. By Ray Vrabel, PharmD

bined number of those abusing cocaine, heroin, hallucinogens, ecstasy and inhal- ants – representing an 80 percent increase since 2000. According to the Web site, substance abuse costs businesses $100 billion annually due to productivity loss, absenteeism and insurance premiums.


cording b site, nesses ue to eism

However, it is surprising to note that prescription drug abuse reaches beyond patients and often affects the very practitioners entrusted with delivering the medication. Healthcare professionals are some of the most common abus- ers of prescription pharmaceuti- cals, which correlates with their easy access to the medications during the normal course of their duties. There are two aspects to drug diversion: (1) the direct and indirect impact on a patient’s care if the patient does not receive the medications that his or her physician intended, and (2) the impact on the healthcare worker who develops a pattern of drug diversion. Hospitals want to keep

ng to drug ents ery


with ion. ls are n abus- c uti-

th their ic

e r s

p cts direc

e t

atient’s rec

or he

e eive h r

cations of thei spe

ccording to the Drug Enforcement A istration (DEA), nearly 7 million Americans are abusing prescrip- tion drugs – more than the com-

ore than the com- abusing cocaine, asy and inhal- percent

e Drug Enforcement Admin- A), nearly 7 million abusing prescrip-

falsifi cation of medication administration documenta- tion, rep acement of a vial o

tion, replacement of a vial of a controlled drug (e.g.,l morphine) with saline, excessive wastage (without actual witnessing), shorting doses of

cation of medication ad cessiv

witnessing), shorting doses of patient medications, sub- stitution

stitution of non-controlled drugs, discrep

discrepancies between actual vs. system


The OmniDispenser module enables healthcare facilities to incorporate secure, automated single-dose dispensing within Omnicell automated dispensing machines.

their patients safe and eliminate the opportunities for employees to divert medications and potentially jeop- ardize their jobs. Early detection can allow hospitals to correct employee behavior before it becomes necessary to impact their employment.

Drug diversion can occur in all clinical areas, including: 18 December 2010

intentional miscounts (both re- stocking on the fl oors and the central pharmacy and activities within stores and the vault). One study showed that drug diversion could be as high as 18 percent among nurses. How- ever, diversion goes be- yond nurses to include physicians, pharmacists and any other employee involved in handling controlled substances. 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. In an effort to meet regulatory compli- ance and prevent diversion, most hospitals have implemented auto- mated dispensing cabinets (ADCs) to provide physical control and limit authorized access using biometrics and

system medication counts and inten

to help nce and pre becob c me

are es

In an effort t

even ha

bar coding. More recently, hospitals are increasingly using special software technology for medication sur- veillance.

The challenge for hospitals is to stay a step ahead of drug diverters. Even with secure cabinets, some divert- ers have found ways to subvert the system by removing


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