January 27, 2017
Host: Kimberly New, JD, BSN, RN Consultant and Subject Matter Expert in Detecting Diversion
- JoAnne Myhre, BA, C PhT, Drug Diversion Program Manager, Allina Health (MN)
- Allyson Fonte, Medication Safety Officer, Mt. Sinai Medical Center (FL)
- Debra Rorie, Pharmacy Implementation Supervisor, Deaconess Health System (IN)
- Sheldon Lefkowitz, Director of Pharmacy, St. Mary's Medical Center (FL)
- Nilesh Desai, Administrator of Pharmacy and Clinical Operations, Hackensack University Medical Center (NJ)
This podcast brings together five experts from health systems across the United States to discuss the topic of drug diversion in healthcare settings and speak about the tools and best practices for detecting and deterring drug diversion.
JoAnne Myhre, from Allina Health, discussed both proactive monitoring tools, and reactive practices and procedures; which they use at their healthcare facilities in Minnesota. One key element of their response when an incident is under investigation is to draw on a multi-disciplinary, Drug Diversion Core Team, who work together to issue a coordinated response. Typically, this is comprised of the Director of Pharmacy, a Nursing Leader, a Safety Officer, and someone from Human Resources. Allina also uses an analytics software to proactively monitor for anomalous activity. Ms. Myhre discusses a recent incident where a nurse was found to have been tampering with and diverting medications and how their group was able to detect and stop the diversion activity.
Allyson Fonte, from Mount Sinai MC, discusses her facility's use of the Pandora Analytics software to discern outliers in normal pharmacy transactions from the Automated Dispensing Cabinets (ADCs). When a nurse at Mt. Sinai seemed to have anomalous usage of Percocet, she placed her under observation and raised the issue with nursing management. As is the case with many diverters, the nurse's manager indicated surprise at the suggestion. While this nurse resigned before a case could be built from the data, the facility was able to tighten up the policies and procedures which had allowed the diversion to occur, and to expanded their staff training on detecting diversion. Ms. Fonte reviews those 'Best Practices' and the lessons learned from this incident.
Debra Rorie, from Deaconess Health System, discussed a particularly challenging case study where a diverter was taking out and using stimulants using another staff member's ID and password. Here the use of cabinet cameras, in addition to the analytics software, was used to piece together a diverter doing everything possible to evade detection. Lessons learned relate to password protection, and unlearning the "It can't be this nurse phenomenon".
Sheldon Lefkowitz, from St. Mary's Medical Center, discusses how far technology has come in assisting Pharmacists in detecting drug diversion. Whereas manual reviews of reports used to take hours, modern analytics software can call out statistical anomalies and minutes. Using this technology and barcoding, we can match up dispensing and administration data and confirm what really took place. Cabinet cameras too, round out the armamentarium available to pharmacists and safety officers in today's medical center.
Nilesh Desai, from Hackensack MC, relays an event which happened with a diverter at his facility. Hackensack also uses Pandora Analytic software and found that anomalous use reports, coupled with patient interviews help to reconstruct a timeline of diversion activities. He particularly likes that all of the users activities can be seen on one screen. Thus pharmacy and safety professionals can review medication orders, administration, returns and narcotics waste all at once. He also discusses working in conjunction with a central audit department for our facility which tracks and trends for the facility.
A question and answer session follows, led by Kimberley New.