Curb­ing health­care drug theft in Minn.

Modern Healthcare - - BEST PRACTICES - By Mau­reen McKin­ney

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 un­der­re­ported 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 wellestab­lished 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.

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