Everyone knows diversion is a major challenge in today’s health care environment, but not everyone knows how to confidently detect, manage, and prevent diversion incidents. Omnicell is proud to announce a four-part webinar series on Diversion Management with special guest Kimberly New. Kim is a leading national expert on drug diversion. As a former compliance specialist at the University of Tennessee Medical Center, Kim became an expert in catching, managing, and ultimately minimizing drug diversion incidents.

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Top 10 Tricks Diverters Use to Steal Medications From Your Hospital - And How to Catch Them Each Time
Kimberly S. New JD BSN RN

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Diversion
•Diversion can’t be prevented entirely
•Facilities must prevent what they can, detect diversion quickly and respond appropriately
•Goal: detect most diversion through analytics
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Role of Analytics
Greatly Improve:
•Ease of audit
•Time required to audit
•Speed with which diversion can be detected
•Documentation of audit
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Think Like a Diverter
•An effective surveillance program requires knowledge of common methods of diversion
•Be aware of the most commonly diverted drugs
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Drugs of Choice
Injectables:
•Hydromorphone
•Morphine
•Fentanyl
•Propofol
Pills and liquids:
•Hydrocodone
•Oxycodone
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Drugs of Choice
•Benzodiazepines (lorazepam, alprazolam, clonazepam)
•Drugs to ease withdrawal and enhance impact of opioid (ondansetron, promethazine, diphenhydramine)
•Barbiturates (phenobarbital)
•Non-scheduled (cyclobenzaprine, gabapentin)
•Anesthesia gases
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Wasting Complete Doses
Detection:
•Anomalous usage reports
•Activity reports
Prevention:
•Educate staff to question this
•Policy to prevent early removal of medication in anticipation of pain
•Require that unused doses be returned to a return bin
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Drug of choice oxycodone
Drug of choice hydromorphone
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Removal Under the Sign-On of a Colleague
Detection:
•Anomalous usage reports
•Activity reports
•Witness buddy report
Prevention:
•Ensure staff know they must never walk away from the cabinet without logging out-including during a waste transaction
•Set cabinet timeout at the shortest workable interval
•Use actual examples in staff education
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Sue’s would “witness” her own waste after Bob signed in. Bob trusted Sue, so as soon as he had logged in, he walked away to attend to other things
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Dropping pills or breaking containers of injectables
Detection:
•Anomalous usage reports
•Activity reports
Drilling Down:
•Look at transactions for other medications (controlled and non-controlled)
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Withdrawing Medication Without an Order
Detection:
•Anomalous usage reports
•User watch list report-compliance
•Activity reports
Prevention:
•Ensure that wherever possible, cabinets are “profiled”
•Limit medications that can be removed by override
•Require meaningful comment when overrides must occur
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Giving Less than Ordered More Frequently
Detection:
•Anomalous usage reports
•Activity reports
Rationale:
•Dividing doses maximizes waste
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One time order for additional hydromorphone for patient because of “break through” pain. Removed two 2 mg hydromorphone syringes for a one time order for 0.2 mg
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Cancelled Transactions
Detection:
•Anomalous usage reports
•User watch list report-compliance
•Activity reports
•Helpful when diversion of opioids suspected
Rationale:
•Medications used to ease symptoms associated with opioid misuse
•May be used to dilute opioids that have been tampered with
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Multiple cancelled transactions for drugs used to ease withdrawal or dilute opioids
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Duplicate Doses
Detection:
•Anomalous usage reports
•Activity reports
Watch for:
•Toggling between drug cabinets
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Duplicate doses and toggling between cabinets 1 and 2
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Removal for Discharged Patient
Detection:
•Anomalous usage reports
•Activity reports
Prevention:
•Review CPOE order entry processes
•Ensure that patients are removed from the system as quickly as possible
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Picking a Noncompliant Witness
Detection:
•Anomalous usage report
•Activity report
•Witness buddy report
Prevention:
•Educate staff about requirement that they must physically witness waste
•Require incident report when waste isn’t witnessed
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Withdrawing Medications for Patients Who Don’t Need Them
Detection:
•Anomalous usage reports
•Activity reports
•Patient safety report
•Medical record entries re: pain/pain relief, vital signs, nursing notes re: patient condition
•Look for contradictory notes
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Conclusion
•Surveillance and auditing require dedicated resources, but yield substantial benefits in terms of safety, institutional reputation and liability
•Detecting diversion quickly is essential to patient safety
•Staff that are caught early have a greater likelihood of successful return to practice, and a decreased chance of social consequence
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Speaker:
Kimberly New, JD BSN RN
(865) 456-1813
Kim_New@zoho.com
Omnicell Contact:
Jose Castanon, MBA
Director, Product Marketing
(650) 251-6010
jose.castanon@omnicell.com
Upcoming Diversion Webinars: Webinar 3: November 4, 2014 Crisis Control: How to Handle Diversion Incidents at Your Hospital Webinar 4: December 2, 2014 Save Lives, Money, and Reputation – Take the Driver’s Seat on Medication Diversion Additional Presentations At The ASHP Midyear 2014:
•Intelligent Pharmacy Pavilion, Tuesday December 9th, 2:20 PM
•Omnicell Exhibit, Booth #589
Register at www.omnicell.com/TLSWebinars
Questions?