How Many Transactions Are Enough?

When it comes to detecting patterns of drug diversion in a patient care setting, timing is everything. A crucial component of this task is determining the right time duration to include when sifting through medication transactions. Should we only focus on recent activities, or should we look over a longer period?

The answer, as with many things in healthcare, is that it depends on the situation. In some cases, diversion may be apparent from a single incident, such as a new employee who immediately starts diverting medications.

However, in most cases, it takes longer to recognize patterns of diversion. Through personal experience and collaboration with fellow experts in the field, we’ve discovered that a longer time range is typically more efficient in identifying true cases of drug diversion versus misread data.

If you’re only looking at a small window of time, say a week or two, it’s easy to come across false positives. For example, a nurse may be assigned to a high-needs patient and have to administer pain medications multiple times in a row over the course of a few shifts.

This spike in dispense numbers might look like drug diversion on paper, but in reality, it’s just a reflection of the patient’s needs at the time. Without paying attention to the bigger picture, it’s too easy to jump to unfounded conclusions.

However, the human brain is excellent at recognizing patterns, and over a longer period of time, any discrepancies in medication administration – including the patterns of drug diversion – will start to become more apparent.

In a day or two, there may be some spikes in prescription rates that can be easily explained, but over a month or a few months, you’ll be able to see a story unfold that clearly indicates patterns of drug diversion.

So, what is the optimal time range to include?

We recommend looking back at least three months, though six months may be preferred in some cases. 

This provides a big enough window to spot patterns, while also taking into account any inconsistencies that might arise due to things like the intensity of a patient’s medication needs or the inexperience of a new employee.

Of course, there’s no such thing as a hard and fast rule when it comes to detecting patterns of drug diversion. Every patient care setting is unique, and it’s important to customize your investigation as needed based on your specific patient population and clinical practice.

However, by using a longer time range to analyze medication transactions, you’ll be giving yourself the best chance to spot any red flags and keep your patients and staff safe.

Terri Vidals
Terri Vidals

Terri has been a pharmacist for over 30 years and is a drug diversion mitigation and monitoring subject matter expert. Her years of experience in various roles within hospital pharmacy have given her real-world insight into risk, compliance, and regulatory requirements, as well as best practices for medication and patient safety.

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