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Systemwide efforts help hospital prevent drug diversion problems

Preventing drug diversion begins with a look at the hospital's overall system, not just at the individuals suspected of stealing drugs.

"Focus on the system, not the employee," says Mitch Sobel, RPh, assistant director of pharmacy for operations at Saint Barnabas Medical Center in Livingston, NJ. "Otherwise, you're never going to figure out what's going on with your system."

JCAHO standard MM.4.80 requires hospitals to have processes in place to address diversion prevention and account for all unused, expired, or returned medications.

Track with technology

Saint Barnabas uses Pyxis automated dispensing units and software to help track medications used in the hospital. Combined with other diversion-prevention efforts (e.g., cosignatures on reports and collaboration from the nursing, security, and medical staff departments), the hospital has had few problems during the past two years, Sobel says.

"Discrepancy issues may occur several times per year on the floors, but now they can be identified and resolved quickly," Sobel says.

The system allows the hospital to run reports by user to see who removes which drugs, how many patients a nurse may have, and how many doses staff remove.

Narcotics are not the only drugs to worry about. For example, the hospital once had a problem with the antidiarrhea drug Lomotil, losing 10,000 tablets per month, Sobel says. However, the hospital only had five patients per month on the drug.

Sobel was able to view the purchase history report to determine how much the hospital bought compared to how many patients used the drug, he says. Now the drug is stored in the hospital's narcotic safe system.

Sobel can also run a report to track practitioner use. For example, a nurse might say he or she has 20 patients per day, although most only have between five and 10, he says. The Pyxis machine can tell whether a nurse pulls more doses than the patient receives, he says.

Human error-not deliberate diversion-is often the cause of discrepancies, Sobel says. Sometimes a staff member may type too fast and enter the wrong quantity into the Pyxis machine and take too much by mistake, he says.

"We're able to catch and correct the error [with an electronic system] before it [affects] or reaches the patient," Sobel says. "We won't hurt the patient with too much medication."

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