Best Practices: Curbing healthcare drug theft

In May 2011, after several highly publicized cases of theft of controlled substances by healthcare workers in Minnesota, state health department officials approached the state hospital association with a plan.

Together they formed a coalition of people from hospitals, law enforcement agencies, long-term-care facilities and public health groups to collaborate on raising awareness, gathering data and developing a road map of steps to prevent so-called drug diversion.

“We looked to high-performing organizations that were already addressing the issue and we gathered those best practices,” said Tania Daniels, vice president of patient safety at the Minnesota Hospital Association.

While there are no exact statistics about the prevalence of drug theft in healthcare facilities, experts agree it's a pervasive problem. “It happens in all hospitals, but it's immensely under-reported and under-detected” said Kimberly New, founder of Diversion Specialists, in Knoxville, Tenn., who previously oversaw diversion prevention at the University of Tennessee Medical Center. “When I launched the program in 2007, I was catching three or four nurses a month,” New said. “But even seven years later with a well-established program in place, I was still catching one or two a month. It's extraordinarily widespread.”

New says hospitals should view diversion as a patient-safety issue, like falls, especially when theft involves injectable drugs and potential risk of infection for patients.

In 2012, a high-profile, multistate outbreak of hepatitis C affecting more than 40 patients was traced to David Kwiatkowski, a traveling medical technician working at 99-bed Exeter (N.H.) Hospital who stole syringes of the painkiller fentanyl, used them to inject himself, then refilled them with saline. Kwiatkowski pleaded guilty to 16 federal charges and was sentenced in December 2013 to 39 years in prison.

“One of the positive outcomes of the Kwiatkowski saga was that it raised awareness and compelled hospitals to take some action,” said Dr. Joseph Perz, quality and standards team leader at the Centers for Disease Control and Prevention.

Hospitals shouldn't wait until there is an infection outbreak to engage public health agencies, Perz said. “Anytime there is evidence of tampering, there needs to be a careful evaluation of infection risk, and that is not something hospitals should engage in on their own,” he said. “They don't need to work in a vacuum.”

Minnesota's collaborative, known as the Controlled Substance Diversion Prevention Coalition, released a road map in March 2012 containing 100 best practices on drug theft-related topics, including surveillance, staff education, drug storage and waste disposal.

For instance, the road map recommends conducting random audits of certain high-risk drugs; forming a multidisciplinary team to oversee diversion prevention; and ensuring empty drug vials are placed in limited-access waste containers. The group also released a toolkit with links to law enforcement websites, sample checklists and other resources.

In 2012, the coalition launched a learning network of volunteer hospitals that share data on their drug-diversion programs and provide each other with feedback. That network has grown to include 45 hospitals, said the hospital association's Daniels. Hospitals submit quarterly data indicating whether they are in compliance with each of the 100 recommendations.

“Statewide, I can see that hospitals have made progress in several areas, including designating a person who oversees diversion and having rapid-response protocols in place for when there is a suspected theft.”

Hospitals still struggle with security issues, she said, especially with measures that involve additional costs, such as installing security cameras in high-risk areas.

Daniels said one step that can have the greatest impact—and the one that hospitals often don't do—is reaching out to local law enforcement agencies early on, before they encounter suspected cases of drug diversion. “Hospitals think they have to handle this on their own and that's not true,” she said. “Law enforcement can be a great resource for education, and engaging with them early makes it much easier to reach out when an actual event occurs.”

New said staff education and culture change are the foundation of a successful diversion program. She agreed that involving law enforcement is critical.

When she was working at the University of Tennessee Medical Center, she invited some new federal Drug Enforcement Administration agents to see her center's anti-diversion program. During their visit, she and the agents talked specifics on collaboration, including how to contact the agents on weekends and who would handle which tasks. “Having that relationship makes it so much easier to reach out when something does happen,” she said.