Enhancing Controlled Substance Diversion Programs: Integrating Medication Verification to Close Gaps in the Waste Workflow
Controlled substance diversion is a significant concern in healthcare facilities, with potentially serious consequences for patient safety, staff integrity, and regulatory compliance. According to the U.S. Department of Justice National Drug Intelligence Center (NDIC), the estimated cost of diversion to public and private medical insurers is more than $72 billion per year. In 2020 alone, the average fine for drug diversion was $585,000, and 70% of all drug diversion incidents involved doctors or nurses. To address this vulnerability, many institutions have implemented diversion prevention programs. However, despite efforts to establish robust protocols, there are gaps in the current systems, particularly in the area of medication verification. In this article, we'll explore how integrating medication verification into diversion prevention programs can close these gaps and enhance overall effectiveness. ASHP published a new tool in April 2024 (https://csdiversion.ashp.org/) highlighting some of the key steps to consider while implementing a controlled substance diversion program.
Understanding the Current Gaps:
In the article "Automation Technology and Diversion Prevention" by Danielle Neal (Automation Technology for Diversion Prevention : May 2022 : Diversion Management - Pharmacy Purchasing & Products Magazine (pppmag.com)) in the May 2022 issue of Pharmacy Purchasing and Products, the author highlights the importance of addressing diversion through advanced technology solutions. However, one critical gap identified is the reliance on the honor system and documentation alone in the closed-loop process.. While documentation is essential, it lacks the ability to verify the actual presence and concentration of controlled substances, leaving room for errors. A witness must ‘trust’ that the clear liquid is what is labeled on the syringe.
Integrating Medication Verification into the waste workflow.:
There are several technologies which can verify the drug type and concentration of partially used meds to be wasted. For example, refractometers have been used for years for ‘spot-checking’ medications. PharmID offers a more comprehensive solution in medication verification technology. By utilizing this platform, healthcare facilities can implement a more robust closed-loop process that verifies the presence and concentration of medications, thereby enhancing diversion prevention efforts. This solution combines advanced Raman spectroscopy molecular verification with automated easy to use algorithmic tools that can be used directly at the point of care to verify the drug and concentration of what is being wasted. It is portable and thus can be performed at the point of waste including procedural areas. This seamless testing can mitigate the tampering of controlled substance medication by ensuring the medication is the same as what was dispensed.
Key Components for Successful Integration:
Standard Operating Procedures (SOPs) Including Controlled Substance Waste Medication Verification: SOPs should be updated to incorporate medication verification processes during the waste process. This includes defining when and how verification should occur, who is responsible for performing the tests, and how discrepancies should be addressed.
Organizational Training and Buy-in: Staff members need to be trained on the importance of medication verification and how to use the verification technology effectively. Additionally, organizational buy-in from leadership is crucial to ensure support and compliance throughout the institution.
Managing Discrepancies: When discrepancies arise, it's essential to have protocols in place to address them. This involves:
Identifying patterns: Similar to other diversion analytics, patterns of discrepancies may indicate potential diversion. One fail may just be one fail due to many reasons.
Incorporating into investigations: Discrepancies should be integrated into broader investigation processes to identify and address potential diversion cases.
Starting Small and Scaling Up: It's okay to start small with random testing in the pharmacy and expand gradually as the procedure becomes normalized within the organization. This could involve starting with random checks of controlled substance waste, tampers, unlabelled syringes, and then progressing to more frequent audits or even implementing point-of-care testing as part of routine procedures.
Benefits of PharmID Waste Verification Platform:
Accuracy: PharmID provides accurate medication verification, reducing the risk of errors or discrepancies.
Efficiency: The platform streamlines the verification process becoming more a part of the regular waste workflow, saving time and resources.
Compliance: By ensuring medications are properly accounted for, PharmIDhelps healthcare facilities maintain compliance with regulatory requirements.
Improved Staff Morale: By reducing the reliance on the honor system and suspicion, waste verification can foster a more trusting and positive work environment for staff.
Conclusion:
Integrating medication verification into controlled substance diversion programs is a crucial step in enhancing overall effectiveness. With the use of advanced medication verification technology solutions like PharmID, healthcare facilities can ensure the integrity of their diversion prevention efforts while maintaining patient safety and regulatory compliance. By establishing SOPs, providing organizational training, managing discrepancies effectively, and starting small before scaling up, institutions can successfully integrate medication verification into their diversion prevention programs.However, it's important to remember that a comprehensive diversion prevention program should also include measures like secure storage, access controls, and prescription monitoring programs. By implementing a multi-layered approach, healthcare facilities can create a robust system to safeguard patients, staff, and the integrity of the healthcare system.