The Mayo Clinic, for example, has been refining its approach to spotting and preventing diversion for more than a decade, says Dr. Keith Berge, an anesthesiologist at the health system's hospital in Rochester, Minn. In July, Berge, Kevin Dillon, the Mayo Clinic's director of pharmacy services, and several others authored an article in Mayo Clinic Proceedings that reviewed the potential harm associated with drug diversion and outlined the system's best practices.
Their strategy, Berge says, includes the use of automated distribution machines for controlled substances, secure waste bins for unused portions of drugs and periodic audits of drug waste to ensure leftover amounts and concentrations correspond with dispensing records.
After implementation of the changes, the number of known incidences of diversion fell to almost zero, Berge says, adding that there have been only two such events in the past 12 years, compared with approximately one or two a year before the new protocols were instituted.
“We didn't anticipate that kind of drop,” Berge says. “I think it puts just enough of an impediment in people's minds. They know we're always watching.”
Berge argues that drug diversion should always be framed as a patient-safety concern rather than a problem of drug enforcement or human resources. “This is truly a patient-safety issue,” he says. “It is a catastrophic thing for a patient to contract hepatitis C in this way and it shouldn't happen.”
Mayo Clinic's experiences with drug diversion were featured at an Oct. 25 conference organized by the New Hampshire Hospital Association. Officials from the association organized the event in response to concerns from members, says Steve Ahnen, the hospital association's president.
The conference drew more than 200 attendees from across the state, including physicians, pharmacists, risk managers, human resources professionals and hospital leaders. “We don't want to reinvent the wheel,” Ahnen says. “We want to learn from other institutions that have experienced similar cases of drug diversion. What are they doing differently, and given their experiences, what would they recommend to us in terms of steps that should be taken?”
Mayo's Dillon explained to attendees how the 21-hospital system redesigned its policies and procedures in the wake of several instances of drug diversion, including one involving a nurse who stole Fentanyl and replaced it with saline solution.
Dr. David Theil, chairman of the anesthesiology department at Rose Medical Center, Denver, and Robert Campbell, a pharmacist and Rose Medical Center's vice president of operations, also spoke at the conference about the hospital's response to a much-publicized 2009 event, when a surgical technician who was fired for drug diversion—and who found a new job in Colorado Springs two weeks after the firing—was found to have diverted Fentanyl and in the process, infected more than 30 patients with hepatitis C. That technician, Kristen Parker, pleaded guilty to charges of tampering with a consumer product and fraudulently obtaining a controlled substance and is now serving a 30-year prison sentence.
“The sharing at the event was phenomenal,” says Anne Diefendorf, vice president for quality and patient safety at the Foundation for Healthy Communities, Concord, N.H., a sister organization of the hospital association. “No one left without a to-do list.”
While it's difficult to know exactly how big of a problem drug diversion in healthcare facilities actually is, experts say it's endemic.
Joseph Perz, an epidemiologist with the Centers for Disease Control and Prevention, contends that diversion of controlled substances affects all hospitals. He says he came to that conclusion after spending years helping state health departments investigate drug diversion cases.
“It's a very large problem with many dimensions,” says Perz, who participated with Dillon and Berge on a September webinar on the topic, conducted by the Premier Safety Institute, a division of the Charlotte, N.C.-based Premier healthcare alliance. “The risks to patients were not understood well until recently.”
Berge agrees: “If hospitals are looking for it, they'll find it.”