Stringent monitoring of controlled substances is a very important part of any Drug Diversion Prevention Program. There are few that would say that monitoring is not a good idea in principle, however in practice it can be difficult. Thorough monitoring often requires time and resources that are not available in busy health care facilities. Here we outline how monitoring can be accomplished with minimum disruption in current workflow.
Three elements of a comprehensive Drug Diversion program are prevention, monitoring & surveillance and investigation. All Health Care Facilities are required to have systems in place to guard against the diversion of controlled substances. Best practices need to be reviewed and implemented to prevent and detect drug diversion. These were discussed briefly in a previous article on our blog. While setting up prevention strategies will reduce the number of diversion events, it is essential to know as soon as possible if controlled substances have been diverted. This is where monitoring & surveillance comes in. With a comprehensive audit approach in place, discrepancies will be detected immediately which will allow you to quickly investigate and determine route cause.
Moving away from the reactive model
There are several different workflow models when it comes to measuring drug diversion in healthcare settings, the most basic being the reactive model. This all-too-common approach relies only on staff members reporting suspicious activity to detect drug diversion. Not surprisingly, this method is not effective, and it also places an extra burden on hospital staff who are already under a lot of pressure. Under-reporting or finding diversion when it has been going for a long time is very common in this model. While easy and inexpensive to implement, the cost of following up on a report of drug diversion is often much higher as evidence has to be gathered and assessed from scratch and in an ad hoc fashion.
Moving to a proactive approach takes the burden away from staff and relies on processes and data. These data driven models not only promote a better work environment, but they also provide a strong basis for assessing possible cases of drug diversion. Instead of relying on the testimony of an employee, data driven models simply compare a set of numbers. For example the quantity of dispenses from the automated dispensing cabinet do not match the quantity documented on the medication administration record. A simple investigation could be carried out to find out the route cause for the discrepancy.
It’s probably not escaped your attention now that prevention is the first stage of implementing a drug diversion strategy and having a robust monitoring process really helps to prevent diversion from happening in the first place.
Create a procedure
One of the biggest institutional concerns around monitoring for drug diversion is the time and cost that it will take to implement and maintain. From the very beginning, it is important to consider what the outcome of your monitoring efforts will be. One of the most valuable things you can generate is a procedure that allows monitoring to fit within your current institutional workflows. With a well thought out procedure, it will be easy to determine the resources needed and importantly, compare these resources to what is currently being used today. Drug diversion is expensive with many direct and indirect costs, and it is important to weigh these against monitoring measures that aim to reduce or eliminate diversion altogether.
Build automation into your monitoring processes where possible
Automation is your friend when it comes to monitoring for drug diversion. Automation is becoming a larger part of professional life and it can help you to implement a robust monitoring system without the additional burden on your staff. Automating your data reporting is one of the easier processes to implement. There are many software tools available that will analyze data from many different sources to identify trends that could be a sign of diversion.
Analytics is a very useful tool for detecting and preventing diversion. It can produce detailed and customizable reports for your monitoring and surveillance program.
An important and sometimes overlooked feature of your monitoring and surveillance program is immediate feedback. There are instruments and data collection methods than can allow information to be sitting on a server for weeks or even months before it is analyzed. This causes a multitude of problems for diversion monitoring. Firstly, if too much time passes between a diversion event and the detection, then it becomes much more difficult to catch the culprit. It is also very difficult to fix problems with the data sources or the data collection if they are only being assessed periodically. Therefore, we always recommend that you generate feedback from your data as quickly as possible. If you use our device, WasteLog®, it is possible to measure the contents and concentration of a controlled substance prior to wasting and the results are immediately collated and shared with the hospital pharmacy office. This makes it much simpler to quickly investigate anomalies. Again, the mere act of recording and investigating small anomalies, even if they turn out to be nothing, is a great prevention strategy.
Choosing the right solution
When choosing a solution, automation is a huge advantage as it allows you to integrate monitoring and surveillance seamlessly into your existing workflow. Our experience is that the least amount of disruption in workflow leads to successful long-term adoption of monitoring and surveillance systems. Automated systems often require an upfront capital investment. When deciding between automated and non-automated solutions a cost analysis can be a key element. Make sure to include the labor cost and time taken away from the core duties of resources to implement and run a non-automated solution.
If you have any questions about this, we will be happy to guide you through how our instrument could be incorporated into your automated monitoring program.