It used to take Piedmont Athens Regional Medical Center weeks, if not months, to discover a possible instance of drug diversion. That’s not uncommon for hospitals—but with mounting deaths across the nation from drug overdoses, in particular from controlled substances, the Georgia facility decided to add a new technique to its discovery process: analytics.
Nearly 50,000 people died from overdoses involving opioids across the U.S. in 2017, the most recent year tracked by the National Institute on Drug Abuse. Drug diversion plays a role in the epidemic.
In the first six months of 2018 alone, healthcare organizations lost more than 18.7 million pills from employee misuse and theft, according to a report from healthcare analytics vendor Protenus. That diversion costs public and private medical insurers $72.5 billion each year, the Justice Department’s National Drug Intelligence Center estimated.
Five years ago, Piedmont Athens Regional addressed drug diversion by relying on medication dispensation reports, which track the number of drugs withdrawn from dispensing cabinets. These reports were compiled every 30 days, but reviewing abnormal dispensing patterns and matching them to a potential perpetrator was time-consuming.
It’s “very, very difficult to backtrack retrospectively and to figure out who was on that unit at the time, what personnel was there (and) who had access to those medications” after discovering a suspicious activity, said Dr. Eric Bour, executive sponsor of parent system’s Piedmont Healthcare’s drug-diversion program.
So, Piedmont Athens Regional began using an analytics tool developed by software company Invistics. The hospital kicked off the program in 2014, when it was known as Athens Regional Medical Center—two years before it was acquired by Piedmont Healthcare in 2016. Now, it’s helping to scale the program.
The tool constantly monitors drug-dispensation, timekeeping and electronic health record systems to flag any suspicious activity, such as if a nurse dispenses two tablets of hydrocodone, but only documents giving one tablet to a patient. It then matches which employees were working at that time and which patients were in the associated unit. From there, the program alerts designated staff—at Piedmont Athens Regional, that means a drug-diversion specialist—about any abnormal patterns, so they can begin investigating as soon as possible—often within hours after the suspicious event occurs, Bour said.
A National Institutes of Health-funded study of the analytics tool found that it took Piedmont Athens Regional anywhere from three weeks to several months to discover a drug-diversion event before implementing the tool. After the hospital began using the tool in 2014, it flagged roughly 200 instances of possible drug diversion, with nearly half leading to full investigations. About 25 care providers faced disciplinary actions as a result of these investigations.
Bour stressed that the tool is meant to be used as a first step, and not as a stand-in for a full investigation. The hospital’s drug-diversion specialist still needed to evaluate whether the abnormality was in response to patient need, a documentation error or was in fact drug diversion.
A comprehensive plan to mitigate drug diversion might include analytics, manual chart reviews, random audits of syringes and even teaching staff how to detect behavioral changes associated with drug diversion among peers, said Robert Campbell, the Joint Commission’s director of clinical standards interpretation for hospital and ambulatory programs.
Piedmont Athens Regional now plans to expand the analytics program across the three other hospitals in Piedmont Healthcare’s eastern hub by fiscal 2020.
However, use of the tool is on hold while Piedmont Athens Regional builds up functionality on the system’s EHR, which it transitioned to late last year.
Bour, who also serves as CEO of Piedmont Newton Hospital, said that expanding the analytics program fits into Piedmont Healthcare’s larger opioid-reduction strategy. “As we’re looking to prescribe less opioids, use less opioids and spare patients from the wrath of opioids, this is just another piece of that whole puzzle,” he said.