Archive May 2018 XIX, No. 5

Safety

5 Ways You Can Prevent Drug Diversion

Kimberly New

Kimberly New, JD, BSN, RN

BIO

Viewing Microscope
LISTEN AND LEARN Make it easy for staff to report suspect behavior or concerns about your facility's medication handling practices.

The opioid epidemic is fueling the growing problem of drug diversion in surgical facilities and attempts to access the controlled substances can happen at any time, no matter how safe your medications might seem or how trustworthy your staff might appear. Follow these steps to ensure your supplies remain in secured locations instead of ending up in the wrong hands.

1Trust, but verify
Always collect sufficient detail about drug transactions. Automated storage and dispensing cabinets are optimal for securing and tracking the use of medications. A locked closet where controlled drugs are "checked out" as needed makes surveillance difficult, but not impossible. If that set-up is in use at your facility, have staff members who pull controlled substances for cases document the date, the time the drug was removed and the time any remaining amount was returned to storage. Auditing drug access and use must be comprehensive and ongoing; ensure accurate and complete amounts for each agent at the start and end of each day to ensure there are no discrepancies.

Some facilities that have manual storage models have nurses pull controlled medications for anesthesia providers. This can facilitate diversion by nursing staff, who may pull more than is necessary and keep the surplus.

I often see facilities put a single staff member in charge of monitoring medication supplies, placing orders and receiving and stocking shipments. Not a wise move. Giving that responsibility to a single staffer eliminates the oversight that's needed to ensure all medications are secure and accounted for. It's best to institute a separation of duties in the drug procurement process in which different staff members are in charge of each step. If your resources aren't big enough to allow for that safeguard, have a staff member witness and sign off on each step of the process performed by the person in charge.

2Secure the sterile field
Close knit staff understandably don't realize that they can't fully trust their colleagues, and so they become complacent about medication security and leave controlled drugs unattended in the OR between cases. The longer drugs remain out of secured storage locations, the more likely they are to be diverted or tampered with.

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