The potential for drug diversion is a threat that exists for all health care facilities. The consequences of diversion are also well documented, and its outcomes are debilitating for patients, providers, and the overall community, not to mention the sometimes substantial financial and security-related impacts. As such, diversion prevention and identification should be a leading priority for all health care institutions.
Key to successfully achieving and maintaining these goals is finding an arsenal of the latest technologies and methodologies to complement your specific practice. Although drug diversion is a problem that affects the entire health care entity, the pharmacy often bears the greatest burden of responsibility for ensuring safe medication practices, and that technology used in the fight against diversion is utilized routinely and efficiently. Among the effective tools available is radio frequency identification (RFID), which has seen increased adoption rates by health care facilities in recent years. Initially utilized to aid in tracking and restocking pharmaceuticals, RFID technology also can be leveraged to help detect and prevent diversion.
Risks for Diversion
The risk for diversion exists wherever controlled substances and drugs of abuse are present. Given that these often-potent medications rely on human interaction for a number of practices, this risk is universal. Furthermore, diversion can happen at any point in the supply chain—during and post-manufacturing, while drugs are in transport, at the multiple points of preparation through administration, and even (or perhaps most likely) when unused medications are in the process of being destroyed.
As long as these powerful medications are in use, the potential for diversion will remain substantial. With this in mind, it is a mistake to assume any circumstance would be free of this risk. For example, there have been multiple documented cases of drug diversion involving law enforcement personnel removing materials from drug drop boxes intended for the safe and secure disposal of personal medications. With this constant risk in mind, vigilance is required at every step in the controlled substances medication use process.
Leveraging RFID Technology
Tools that help prevent and detect diversion are essential, particularly those that support secure storage and staff accountability. Diversion prevention is of course the ultimate goal; however, it should be understood that it is unlikely that diversion can be eliminated entirely. Because of this, prompt detection is extremely important.
RFID technology offers facilities the ability to track medications throughout their movements and identify detours and missing products at any point in the continuum. Aside from its benefits in managing kit and tray assembly, assisting in managing drug shortages, and reducing the potential for human error, RFID technology can also help ensure accountability across the chain of custody spectrum, particularly when prepared medication kits and trays are used.
Furthermore, expanded analytics and real time notification of suspicious activity can be very helpful to identify weaknesses and blind spots (ie, diversion opportunities) and help identify actual diversion. Feeding RFID tracking data into advanced diversion analytics programs has the potential to add metrics that can enhance detection capabilities.
At one moderate-sized academic health care facility, RFID technology was used to trace the path of vials of controlled substances after a large stash of empty vials was discovered in a suspicious location. The vials were part of kits dispensed to anesthesia providers, and RFID tracking helped ascertain a timeframe for when the vials were dispensed. This allowed the facility to identify staff who might have been involved and helped rule out other staff, as anesthesia providers rotated through the facility and staff differed from week to week.
Keep in mind that the use of RFID technology can be expanded beyond tracking medications. Several facilities have utilized RFID technology to track physical keys used to access controlled substances, such as PCA keys and manual storage keys, as well as numerous other devices and supplies, including smart pumps.
Utilize Data to Trend and Anticipate
RFID technology can provide data that shows abnormalities in the handling of controlled substances. It can, for instance, pinpoint when a medication deviates from its intended path. Diversion related anomalies that occur as deviations from the intended path may be associated with tampering schemes or outright theft. Because medication can be tracked at the scale of a single dose, there is a greater possibility of identifying exactly when the deviation occurs via RFID. This can also help in solving discrepancies that are not necessarily diversion related, for example, those in which a vial is mislaid but not actually stolen.
It is important to recognize that RFID cannot tell us if a medication was administered to a patient. Consequently, RFID technology must be used in conjunction with other technologies and measures, such as diversion analytics programs and staff awareness training in order to build a comprehensive diversion management program.
Having an onsite expert or technology owner is highly recommended when implementing RFID technology for any purpose, including diversion management. Accordingly, training should be led by a staff member who is familiar with the technology’s capabilities and also clinically sophisticated in order to maximize the overall benefit of the technology.
Investing in a strong diversion program can be costly, but the alternative risk is more so. While addressing diversion properly requires time, effort, and funds to create an effective program, diversion is a crime that has seriously detrimental impacts on a health care facility, its staff and patients, and the community at large. When investing in technology like RFID, the beneficial impacts in terms of patient safety, staff safety, and inventory management can be tremendous. Ultimately, these benefits will far outweigh the costs.
Kim New, JD, BSN, RN is a specialist in controlled substance security and DEA compliance. She has served as a consultant to healthcare facilities across the country, helping set up and expand drug diversion programs to improve patient safety. Kim currently works remotely as a diversion program consultant with a large US health system. She lives in France with her husband and her beagle Jacques.