ASHP Ask The Expert Session Drug Diversion

Yes. The calculation of our risk score is displayed transparently, with an easy-to-understand list showing which alerts were triggered and how much risk was increased by each alert. This is a strength of our analytics and AI compared to competing approaches that obfuscate their calculations or use neural networks that typical software users need help to explain, understand, or interpret easily. This approach is essential for investigators/auditors to trust that the risk score calculations are accurate and understandable.

Sentri7 Drug Diversion monitors shipments sent directly from the wholesaler or 503B vendor to the pharmacy and received in the narcotic vault. Sentri7 Drug Diversion reconciles the shipped quantities with the amounts received to detect if any shipments of medications are missing. We work directly with the wholesaler to extract the data and collect the necessary information.

Identifying clinicians who dispense or waste more than their peers provides some insight into practice behavior but does not always guarantee diversion. We must consider patient acuity (i.e., oncology, palliative care, emergency department), number of shifts worked, and peer comparison. Examining the clinician globally over time and assessing stronger determinants such as missing medications may help provide a more informed investigation and analysis of a clinician's overall behavior pattern.

The use of a drug diversion surveillance application such as Sentri7 Drug Diversion allows for peer comparisons of different user groups. A user’s role may be identified in the time and attendance data and used to populate distinct user groups, which quickly identify float/contract/watch-list/residents, etc. Sentri7 dashboards can be filtered to create peer comparison visualizations for a given user group quickly. Labeling these distinct groups of clinicians improves the accuracy of surveillance.

We recommend using a drug diversion surveillance application to integrate users across multiple disciplines. Sentri7 Drug Diversion facilitates quick recognition and identification of potential risky behavior. The ability to monitor across the continuum of care, along with bidirectional communication, automated alerts, and scheduling of reports/dashboards between disciplines, makes this possible.

ASHP has various resources available via its Diversion Prevention webpage, including a Controlled Substance Diversion Program Gap Assessment Tool. This tool aligns with best practice recommendations in the ASHP Guidelines on Preventing Diversion of Controlled Substances. 

Yes, active real-time surveillance of multiple aspects of peri-procedural care helps facilitate a more accurate assessment of activities in these areas. Examples of behavior patterns in the Anesthesia department that may benefit drug diversion investigation include missing administrations, missing wastes, procedural timing alerts, missing bar-code scanning, and Provider-Log alerts. Enhanced reporting is also an available tool in Sentri7 for understanding which anesthesia provider may be administering more narcotics for a given procedure than peers performing that same procedure using normalized data per procedure on an MME/Kg basis.

A comprehensive drug diversion surveillance application should provide tools to help identify a clinician's total risk profile and patterns related to documentation challenges. Examples of alerts that help target these patterns include pain score trends, ADC discrepancies, canceled transactions, and high usage (heavy hitter).

Yes, the Sentri7 Drug Diversion software can reconcile IV infusions and PCAs. Transactions are analyzed on a volume basis to determine if the amounts dispensed reconcile with the amounts administered, wasted, and returned (including amounts used in priming the tubing and bolus doses). The ability to capture and monitor infusions at all main access points is pivotal to identifying potential drug diversion throughout the supply chain.

Hospital operations that should be monitored for drug diversion include automated dispensing cabinets, Electronic Medical Records, Narcotic Vault Transactions, Wholesaler shipments, Employee Timeclocks, and Reverse Distributor shipments.

ADC transactions that may indicate risky behavior patterns include override alerts, patterns of wasting full vials or tablets, canceled transactions, forced entry, inventory adjustments, and accessing ADC machines when not on a scheduled shift or in an unassigned care area.

Yes, Sentri7 Drug Diversion can identify inconsistencies in a charted pain score with the required pain score for a particular medication dose.