Drug diversion risks patient safety, preventing patients from receiving prescribed medications, and could result in exposure to blood-borne pathogens and other risks.
Although drug diversion is not a new concept, ways to identify, investigate, and respond to these events are evolving. While the roles and responsibilities for drug diversion planning and response are well defined, the role of the infection preventionist (IP) is frequently not well defined.
Drug diversion and its effects on hospitals and patients
Drug diversion is the theft or deviation of a prescription medication from its intended path from the manufacturer to patients or facility itself. While drug diversion can happen even before the medication arrives at the facility to sell, the risk to patient safety in healthcare settings occurs when healthcare personnel (HCPs) illegally obtain medications for personal use.
Hospitals bear the fiscal impact in many ways:
- Non-reimbursed replacement medications
- Impaired staff and absenteeism
- Fines associated with the Drug Enforcement Administration (DEA) or Centers for Medicare and Medicaid (CMS)
- Negative press
And, drug diversion harms patients in several ways:
- Denied medications that increase suffering or lead to patient harm
- Inaccurate medical record documentation that impacts care plans
- Patient safety impacts due to impaired healthcare workers
- Exposure to infectious diseases if injectable medications are involved
The case of an alleged drug diversion in Medford, Oregon underscores both the impact to individual patients and their families and the hospital. With 44 identified patients to date and 16 deaths related to bloodstream infections, a nurse stands accused of swapping tap water for narcotics occurring between 2002 and 2023.
How is drug diversion identified in hospitals?
Drug diversion detection can be challenging. The signs and symptoms of impaired healthcare workers are illustrated in 2019 HAI Council of State and Territorial Epidemiologists Drug Diversion Toolkit, Appendix 8. The DEA states an employee “has an obligation” to report suspected diversion. Despite methods to report anonymously, HCPs may be in denial that a co-worker would engage in drug diversion activity, have concerns about retribution, or be wary about being involved in an investigation. In the case of the Medford case, a spike in central-line associated bloodstream infections (CLABSIs) may have been a warning sign. A news report in June 2024 indicated the hospital reported a significant rise in identified CLABSIs.
Healthcare associated infection (HAI) surveillance is a standardized, consistent method used by IPs to identify unusual trends of outcome measures, positioning the IP in an integral role of drug diversion identification. Electronic surveillance systems, such as Sentri7 Drug Diversion, use machine learning and alerts to further support the identification of suspected diversion activity down to the individual level.