In a recent article in Pharmacy Purchasing & Products, authors Blake Barta and Tyler Vest discussed the effects of drug diversion, including needless anguish to patients who receive insufficient analgesic relief, potentially unsafe care from a healthcare worker due to his/her impaired performance, and the expanded risk of infection in patients due to contaminated syringes. They also noted the potential civil and criminal penalties and the risk of overdose and death in healthcare workers who may divert drugs.

The authors wrote that it is imperative that hospitals implement a medication-use process to combat drug diversion and that facilities should evaluate each step in the process to identify vulnerabilities. The steps identified in the medication-use process include 1) procurement and storage, 2) prescribing, 3) preparation and dispensing, 4) administration, and 5) waste and destruction. They noted that at the procurement and storage stage, possible signs of drug diversion include compromised product containers as well as misplaced or changed packing slips. With regard to storage, unsupervised access to drug-storage areas is a specific concern, as tampering may occur when there is an absence of oversight.

IV medications, they contended, are often targeted, with the diverter appropriating drug from the container while ensuring that  the container seems to be intact and then replacing the diverted drug with saline to conceal evidence of tampering. At the prescribing stage, flexible ordering and unverified verbal orders in the ambulatory care setting are potential indicators of diversion.

During the preparation and dispensing stage, drugs that entail compounding and repackaging may be diverted. The authors also note that there is expanded risk of diversion among staff delivering medication to the units if there is poor verification of dispensing processes. In this situation, the delivery individual can divert product by forging the signature of the second verifier.

In the administration stage, there are several ways that drug diversion can occur. For example, workers diverting drugs frequently substitute saline for the diverted drug and then administer the adulterated (and possibly contaminated) product to the patient.

In the final stage, waste and destruction, warning signs for drug diversion may include anomalies in the wasting process, fabrication of witnessing, visual confirmation of wasting that does not detect drug content, unsecured waste receptacles, and a poorly controlled return process for expired products.

The authors conclude that recognizing weaknesses in the medication-use process is the first step to creating effective prevention strategies. Additionally, identifying the signs of drug diversion and incorporating targeted prevention strategies create the essential support for a strong controlled-substances diversion-prevention program. They also note that organizations can produce a culture of knowledge and accountability that involves a collaborative effort between the healthcare workers throughout the organization to recognize and avert drug diversion.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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