CASE STUDY
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I’m involved with The American Society of Health System Pharmacists (ASHP) and apply their
strategies to diversion prevention program.
Q. What solutions are Children’s Mercy applying today?
I view a successful diversion control solution as having four legs, consisting of:
1. Hardware: The hospital needs an automated dispensing system in various locations, such as
the operating room or nursing units.
2. Software: Diversion systems have come a long way in the last 20 years. Health systems have
benefited from the accuracy of audits and true positives.
3. Human Resource: The system is only as good as the employee who knows how to use and
maximize the capabilities. It benefits significantly from a savvy technician. Make an investment.
4. Culture: Everyone needs to look for warning signs across their system. Red flags exist. And the
staff needs to drive out the thought that it wouldn’t happen here because diversion happens.
Q. What resources are needed to monitor controlled substances?
At Children’s, our pharmacists or pharmacist technicians are responsible for working with the
nursing staff to review the reports. They are the detectives who use the system as their metal
detector to find that needle in the haystack.
Q. With the abundance of data analytics available, how do you use the data for decision-making?
From our system, we are hyper-focused on specific reports. We run aggregated reports on
practice variables, such as the movement or removal of excessive doses. The system flags high
transactions from individuals.
Another critical report for us is the purchase versus receipt. It shows reconciled data from
the wholesaler within our controlled inventory. Our system allows us to watch for ordered
pharmaceuticals that were not logged into the system.
Q. What is the essential data point in detecting diversion?
One of the most significant causes of concern is when a drug is removed and not accounted for
in the system. The starting point to the answer is, “Where should it be?” A successful diversion
program needs a robust reconciliation process.
Q. Based on your expertise, what is your guidance on a monitoring system for drug diversion?
A good starting place is the Guidelines on Preventing Diversion of Controlled Substances from
the American Society of Health-System Pharmacists. Hospital management will receive a robust
blueprint to help focus resources, build capabilities, and implement a collaborative, comprehensive
controlled substance diversion prevention program.
Final Thoughts From Brian
One area that needs more attention is analytics to understand and address drug diversion in retail
and ambulatory pharmacies. Ample transactions and inventory benefit from robust monitoring and
advanced analytics.
Profile: Retired Chief Nurse Officer, Barbara Jacobs, MSN, Anne Arundel Medical Center
Q. How did your role relate to preventing diversion and protecting patients?
I was the chief nurse officer for the 384-bed at Anne Arundel Medical Center, where I guided nursing
care throughout the facility, partnering with many experts in medical specialty areas. The care and
safety of patients were my responsibilities, which included initiatives to stop drug diversion.
Q. Thoughts on the state of drug diversion at hospitals given COVID and staff shortages?
The Pandemic presented a potential for increased diversion, as did the temporary staffing due to
shortages. Nursing is about trusting relationships, and with an influx of travel nurses in the hospital,
nursing leadership didn’t have a history with travel nurses nor the time to get to know them.
Nurses' stress level and diversion have always been my concern, and it accelerated during COVID.
Everyone needs to
look for warning signs
across their system.
Red flags exist.
And the staff needs to
drive out the thought
that it wouldn’t
happen here because
diversion happens.”
Brian O’Neal, PharmD, MS, FASHP
Senior Vice President
~ Allied Health at Children’s Mercy
Kansas City, MO