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Development of a Road Map to Controlled Substance Diversion Prevention

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Title: Development of a Road Map to Controlled Substance Diversion Prevention


1
Development of a Road Map to Controlled Substance
Diversion Prevention
  • Rene Cronquist, RN, J.D.
  • Director of Practice and Policy
  • Minnesota Board of Nursing

2
In the news.
  • Prison Sought for Nurse Who Stole Drugs
  • Nurse Accused of Stealing Patients
    Prescription
  • Nurse Pleads Guilty to Stealing Narcotics from
    Patients

3
Concerns
  • Patient safety
  • Patients deprived of necessary pain medications
  • Potential for overmedication if subsequent doses
    are adjusted based on lack of pain relief
  • Infection (contaminated IV meds)
  • Nurse impairment while on duty
  • Fear, reluctance to trust nurses
  • Cost

4
Beyond the headlines
  • Controlled substance diversion is a problem that
    concerns a number of parties.
  • Each party had been addressing the problem from
    their point of view, with little coordination
    among the parties.

5
How to build a better mousetrap
  • May 2011 the Minnesota Department of Health and
    the Minnesota Hospital Association assembled a
    coalition of stakeholders to address controlled
    substance diversion.
  • Many of the parties that ultimately became
    involved in this project had a history of working
    together on other patient safety issues through
    the Minnesota Alliance of Patient Safety (MAPS).

6
The Coalition
  • Participants included representatives from
  • Associations of health care organizations
  • Infection Control
  • County attorney
  • Law enforcement local, DEA and FDA
  • Large health systems
  • Retail pharmacy health system pharmacists
  • Health Boards (Nursing, Medicine, Pharmacy)
  • Boards alternative monitoring program (HPSP)

7
Narrowing the Universe
  • The Coalition quickly realized the problem of
    drug diversion is vast and multifaceted. To be
    timely and effective, the group decided to be
    clear and concise about its focus.
  • The focus became controlled substance diversion
    (as opposed to all drugs that might be diverted)
    and the acute care setting (hospitals).

8
Objectives
  • Identify best practices and resources to prevent
    and increase awareness of diversion.
  • Guidance to parties on how, when and with whom
    information may, can and/or must be shared.
  • Recommend measures to quantify cases of
    diversion.
  • Disseminate information to health care providers
    and organizations and the public.

9
How to accomplish the work
  • Work groups
  • Best practices/resources for prevention,
    awareness and detection of diversion
  • Communication across coalition organizations and
    investigative organizations
  • State and Federal reporting obligations
  • Dissemination of resource materials
  • Identification of measurements to gauge scope of
    the issue and impact of the coalition work

10
Prevention Roadmap Outline
  • SAFE infrastructure
  • Best Practices Principles
  • Tool Kit

11
SAFE
  • S Safety teams/Organizational structure
  • A Access to information
  • F Facility expectations
  • E Educate staff and patients

12
SAFE infrastructure
  • Organization defines, and the structure supports,
    an effective CS diversion prevention program
  • Proactive collaboration with law enforcement
  • Commitment to collection, auditing and review of
    relevant data
  • Organization sets and communicates expectation
    that staff speak up when a potential diversion
    concern is identified
  • HR practices support organization-wide diversion
    program

13
Best Practices
  • Procurement
  • Storage and security
  • Prescribing
  • Preparation and dispensing
  • Administration of CS
  • Handling wastage
  • Follow-up if diversion is suspected

14
Tools in the Tool Kit
  • Includes
  • State and Federal laws and rules
  • Diversion Prevention Coordinator position
    description
  • Internal investigation checklists
  • Diversion investigation agencies
  • Diversion reporting obligation flow sheet
  • Articles and websites regarding substance abuse
    and identifying the impaired practitioner

15
Diversion Investigation Teams
  • Recommendation for a team to respond to any
    irregularity in controlled substances.
  • Team assists with determining what investigation
    is appropriate and coordinates or assists with
    coordination of investigation.
  • Examples Code N or Drug Diversion Investigations
    Resource Team (D DIRT)
  • Includes reporting to external agencies (e.g. law
    enforcement and Boards)

16
Outcomes of the Process
  • Very beneficial to have the wide array of
    participants.
  • In addition to identifying best practices, the
    coalition members developed helpful connections
    with other members. Better understanding of the
    roles, perspectives and challenges of each party.
    (Knowing who to call about what and when)
  • Greater buy-in
  • More outlets for dissemination of information

17
Next steps
  • Disseminate information
  • Encourage adoption of best practices
  • Continued communication among coalition members
  • Measure effectiveness
  • Develop tools for other healthcare settings

18
Report, Roadmap and Toolkit
  • http//www.mnhospitals.org/inc/data/drug-diversion
    -toolkit/drug-diversion-final-report-March2012.pdf
  • http//www.mnhospitals.org/inc/data/drug-diversion
    -toolkit/controlled-substance-diversion-prevention
    -roadmap.pdf
  • The Minnesota Hospital Association - Controlled
    Substance Diversion Toolkit
  • All of the above will soon be posted on Boards
    website www.NursingBoard.state.mn.us
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