Rxpert Solutions- Drug Diversion

Drug diversion is a real concern in the healthcare setting. It is estimated that 10% of nurses are dependent on some type of drug. Hospital staff are as vulnerable as the rest of the population to addiction. When you consider that vulnerability, and add to it the access healthcare providers have to the addictive medications, steps must be put in place to monitor for diversion. Allowing a healthcare provider to divert medications from the intended path (the patient) to themselves results in multiple points of risk.

Patient Risk

The primary victim of diversion is the patient. The risk to the patient can vary anywhere from being cared for by an impaired healthcare provider who is not at the top of his or her game, to being infected with contaminated drug supply which can lead to lifelong illness or permanent harm.

Hospital Risk

Healthcare facilities have an obligation to protect their patients. Facilities that don’t, risk legal and regulatory consequences as well as negative publicity and financial implications. All facilities must have a diversion program in place to monitor and respond if a diversion incident does take place. There are multiple state and federal agencies that enforce existing laws and regulations, and they will hold facilities accountable in the event of an incident. Regulatory agencies also survey with respect to accountability of controlled substances and will ask to see how a facility handles chain of custody and monitoring. Have you educated your staff to their obligation to report?
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Healthcare Provider Risk

Let us not forget the healthcare provider. The staff work as a team and if there is an impaired team member it puts all members at risk. The member at the highest risk is the addict themselves. Having a solid monitoring program in place will help facilities identify signs of diversion and impairment sooner rather than later with the goal of getting help for the employee as soon as possible.

Our pharmacy consultants at Rxpert Solutions offer a comprehensive approach to diversion monitoring. We have years of experience in this area and can assist you in developing a program for your facility, assess risks within your current program, work with you to create solutions, aid in monitoring, and provide training and education.

I hired Terri (lead pharmacy consultant for Rxpert Solutions) to develop a controlled substance monitoring program for our 397 bed hospital. Terri performed a complete risk assessment of our practices and put a comprehensive program in place. It involved not only monthly audit reviews of nurse activity, but other monitoring practices within the pharmacy and on the nursing units. She worked well with nurse managers and educated them on what to look for and how to interpret the pharmacy generated audit results. She was a sounding board for them if they had concerns and they would often look to her for direction on next steps. Terri emphasized the need to report suspected diversion cases to the appropriate agencies including the Board of Nursing, and with her help, a process of reporting was implemented. Terri also recognized the need to get help for healthcare providers with addiction issues. She would train the nurse managers with this in mind and encourage them to take this approach with staff. She also gave regular education to staff and new nurse graduates on the risks of addiction, how to recognize it and how to get help if needed.
Prior to the implementation of this program, I was not aware of any staff at this facility being disciplined for suspected or confirmed diversion. Within the first month of implementation of the program, nurses were literally handing over their badge to their manager when confronted. In the first year of the program, 23 staff members had been terminated and reported for suspected diversion. This was no longer a facility that allowed a free for all with controlled substances. Terri helped us make it a safer place all around and the program continues with success.
Terri has a lot of experience and an instinct I learned to listen to when she thought something was “off”. She balances compassion, intolerance for diversion, safe patient care, and the ability to engage the team to find solutions that make a difference. I would highly recommend her for any hospital looking to start or improve their diversion program.

Victoria Hong, Pharm D

Director of Pharmacy

Our References

Terri is absolutely phenomenal. She is an incredibly knowledgeable pharmacy resource. As the medication safety officer, the quality initiatives she implemented not only impacted the patients at our medical center but also reached into the community. Terri is a genuine professional who upholds accountability while creating community among her team members. She is a great listener to identify friction points and has actionable ideas to implement improvements.

Lab

T. Eagle. MBA, MLS(ASCP), CLS Lab Operations Manager

Terri is an expert at prospective risk identification -Failure, Mode and Effects Analysis (FMEA). Terri participated in CHPSO Patient Safety Safe Tables and was part of the Hospital Quality Institute’s Regional Quality and Patient Safety Leader Network.
She is an excellent public speaker and communicates well with public and professional audiences. I look forward to her continued work in medication safety.

Regional Quality Network at HQI

A. Munoz, FACHE, CPHQ, CPPS VP

Terri has done a tremendous job with the controlled substance diversion program. She has had such a positive impact and has really made the hospital a safer place.

Tri-City Medical Center

Nurse Manager

We would not be where we are with the improvements we have made with opioid prescribing if it were not for Terri driving the process.

Tri-City Emergency Medical Group

Chief Physician

In addition to understanding the ins and outs of the [controlled substance use] process completely, she is very proactive in coming to me with provider issues that she detects. She truly balances the administrative duties and the regulatory components demand with a keen sense of what my practitioners do and what their needs are on the ground. Terri is instrumental in working with my department, balancing patient care, cooperation, ability, and integrity to get the job done.

UCSD Medical Center

Chief Anesthesiologist

Terri is knowledgeable and effective in pharmacy leadership. She has the ability to be able to anticipate and prepare for the future. Her ability to utilize resources effectively in this changing environment is a strong asset. She can adapt, evolve, mentor and still never say “no” when asked to assist. She exhibits great abilities to be flexible and is a “self starter”. She has a pleasant yet effective demeanor that commands results.

Candace Fong, Pharm D

System Director of Pharmacy and Medication Safety Common Spirit Health

Terri has always impressed me as being very smart. resourceful, creative, and easy to work with. Terri’s commitment to medication safety permeated our organization, raising the awareness of this important issue throughout all levels of the institution. Terri has always been engaged, cooperative, and generous with her time.

Cary Mells, MD

Chairman of the Department of Emergency Medicine Tri-City Medical Center

Terri has done more for the Pharmacy in her few months as Interim Pharmacy Director than any other Director has done during my 12 years here.

Anita Kennedy, MBA

VP of Ancillary Services Methodist Hospital

Drug Diversion

Patient Risk

Hospital Risk

Healthcare Provider Risk

Victoria Hong, Pharm D

Our References

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