Healthcare staffing hasn’t recovered in the wake of Covid, which is now impacting patients in new and unforeseen ways. In 2021 alone, an estimated 333,942 healthcare providers left their jobs, triggering shortages throughout the U.S. that’s fueled current issues, from overcrowded hospital maternity wards to delayed emergency care services.
But there are other less-publicized fallouts of staffing declines that could nevertheless have an outsized impact in 2024. First among them: healthcare drug diversion, specifically the theft of drugs from healthcare facilities by doctors, nurses, pharmacists, or other clinicians.
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As a newly released study indicates: 69% of respondents cited an increase in floating staff or contract workers, which a majority say has made drug diversion monitoring more challenging. These trends have made it easier to divert drugs, and — given the subsequent rise in substance-use disorders in the U.S. — potentially more likely to occur.
Understanding drug diversion’s impact
A recent story chronicled by The New York Times podcast ‘The Retrievals’ underscores the impact of drug diversion by showing how one clinicians’ decision to divert medication caused physical harm and lifelong trauma for dozens of patients.
In 2021, Donna Monticone, a nurse responsible for ordering and inventorying controlled substances at the Yale Fertility Center in Orange, Connecticut, pleaded guilty to federal charges of tampering with medications intended for patient use. The investigation revealed that approximately 75% of the fentanyl given to patients at the clinic from June to October 2020 was adulterated with saline, which caused excruciating pain for multiple women undergoing In vitro fertilization (IVF) egg retrievals.
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In exchange for her plea, Monticone surrendered her nursing license and was sentenced to four weekends in prison and three additional months of home confinement. But while her sentencing was respectively light, Yale has been sued by dozens of patients and fined $308,250 by the DOJ to resolve allocations that the university violated the Controlled Substances Act. The monetary penalties don’t include reputational damage that may result in the loss of future business.
Incidents like these are chilling reminders that drug diversion can happen anywhere — in spite of Joint Commission guidelines, safety protocols, and background checks. Yale New Haven Health, incidentally, is one of Connecticut’s largest and most distinguished health networks. Monticone wasn’t a contracted worker — in fact her colleagues/supervisors had worked with her for some time and still didn’t detect diversion soon enough.
This story also underscores the importance of staff training: As a July 2023 article published by TODAY noted, it wasn’t until an anesthesiologist working at the clinic noticed how easily a cap popped off a fentanyl vial that staff discovered the truth.
Closing the gaps
It’s not surprising, given cases like the one at Yale, that only 40% of health leaders surveyed say they are “very confident” in their health system’s drug diversion program. And while we’re making big strides in embracing technology to improve detection, diversion requires a more holistic, multifaceted approach.
Here’s three ways organizations can lower their risks of diversion:
- Tighten up the diversion chain of command. Assign a dedicated point person for drug diversion prevention and provide that person the training and support needed both to improve policies and procedures that will proactively reduce potential future diversion. Train a multi-disciplinary team from nursing, pharmacy, medical staff, human resources, compliance that can rapidly investigate future suspected diversion cases. And ensure Human resource professionals complete employee background checks, especially for short-term or traveling clinical staff who may have worked in different states.
- Bolster internal staff training. Equipping staff with the knowledge they need to recognize and respond to drug diversion can mean the difference between an incident like what happened at Yale Fertility Center and an early intervention. At a minimum, health systems should provide frequent training on common red flags associated with drug diversion and how to access resources for additional information and guidance. This training should focus on helping any person who has started to divert drugs to get the help they need to treat their substance use disorder (SUD), before they hurt themselves or their patients.
- Upgrade drug diversion detection technology. As a February 2022 retrospective study published by the American Journal of Health-System Pharmacy noted, advanced analytics and machine learning technologies detected known diversion cases an average of 160 days faster than existing, non-machine learning detection methods, and with 96.3% accuracy. The good news is that a growing number of healthcare organizations are getting this: AI/ML prevention and detection tools have seen the biggest increase in adoption rates compared to other diversion program tools currently in use. More than half (56%) of respondents use AI/ML to identify and prevent drug diversion incidents compared with only 29% of respondents in 2019. What’s more, 53% of those who use AI/ML detection tools are “very confident” in their drug diversion programs, while only 23% of those who do not use AI/ML detection tools feel the same level of confidence.
While there will never be a perfect solution to preventing drug diversion 100% of the time, leveraging the right people, processes and technology is our best chance of keeping patients safe. Aligning best practices in staff training, oversight, and technology can make a meaningful impact at every level.
Photo: Stas_V, Getty Images
Tom Knight is the founder of Invistics, now part of Wolters Kluwer. Prior to founding Invistics, Tom spent 10 years improving supply chains as a manufacturing manager at Alcoa and Siemens.
Karen Kobelski, Vice President and General Manager of Clinical Surveillance Compliance and Data Solutions, at Wolters Kluwer. With more than 25 years of leadership experience, Karen Kobelski is an innovative leader in healthcare technology with multi-disciplined, global experience in driving market-leading solutions that provide clinical surveillance, risk detection and data normalization to improve the quality of patient care, regulatory compliance, and operational performance of organizations in the healthcare industry.
