Posted on November 15, 2018 in: Patient Safety
By Julie Schmidt, Pharm.D., BCPS, clinical pharmacist, Bronson Methodist Hospital, Kalamazoo
It is safe to say we have all heard of the opioid epidemic currently happening in our nation and the effects it is having in our communities. If you are not aware of this situation, please refer to our mainstay pharmacy reference, Google, where you will find countless articles regarding the detrimental effects these medications are having on people and communities. What may not be the first article that pops up is an article about a local pharmacist with an opioid addiction, or a nurse caught for “pocketing” the fentanyl she pulled from an automated dispensing cabinet that was really supposed to be given to a patient. While you may not exactly find these specific stories on Google, I can assure that you will find plenty that share extreme similarities. While the rest of the nation continues to fight the opioid epidemic in the streets, perhaps we should take a little closer look in our own workplaces.
Data from the American Nurses Association report that about one in 10 nurses are thought to be abusing drugs and may be impaired while taking care of patients. While the overall incidence of drug abuse is about the same in healthcare workers compared to the general population, healthcare workers have some exclusive patterns to their population regarding drug abuse. For example, healthcare workers are more likely to misuse prescription medications as compared to street drugs since prescription medications are often easy to access. While healthcare workers experience every day stressors just like the general population, they are also known to experience stress from handling patient illness and death, long hours and demanding work. Unfortunately, the misuse of these medications not only affects the one abusing them, but they may also directly impact patients. As a result of diversion in a healthcare setting, patients may receive diluted medications, infections from contaminated needles/syringes and potential errors if the healthcare professional is impaired.
How do we avoid medication diversion in our own workplace? First off, expect it. This does not mean it is acceptable, but rather it means that steps need to be taken in order to prevent it in the first place. This may include, but is not limited to, ensuring access is only given to necessary personnel, regular auditing and utilizing technology such as automated dispensing cabinets (ADCs). ADCs may be helpful in tracking medication diversion by recording trends, keeping a rolling inventory of medications and ensuring there is a systematic way to document waste. Together with ADCs, hospitals and other healthcare systems should have established policies to identify those responsible for drug diversion, ensure reporting is completed on a routine basis and execute disciplinary action as necessary.
In addition to the steps listed above, many helpful resources are available online when evaluating your own workplace’s policies and procedures regarding medication diversion. See references below for access to some of these resources. By regulating controlled substances in our workplace and making sure policies and procedures are followed, we can help protect not only ourselves and coworkers from potential misuse, but also our patients from unnecessary negative impacts.