p5 and p6

 Deactivated

Kelie Hein 

2 posts

Re:Topic 3 DQ 1

As a reminder, my project topic is medication diversion in a hospital setting, and how it effects patient care.

The first article I chose to summarize for this post is Diversion of drugs within healthcare facilities, a multiple-victim crime: Patterns of diversion, scope, consequences, detection, and prevention by Berge, et al.  The article addresses risk and solutions, and ideas for deterring diversion; and presents vignettes of actual diversion cases.  The article begins with a definition: "Diversion means the transfer of a controlled subsance from a lawful to an unlawful channel for distribution or use" (Berge, et al., 2012, pg. 674), and goes on to relate that diversion is "associated with adverse consequences, the scope of which is incalculable, with harm to the drug diverter and others that is at times horrific" (Berge, et al., 2012, pg. 674).  Harm can befall patients, the diverter, colleagues, and the employer.  Diversion creates issues with trust, and requires the help of risk management and ethics.  "Diversion causes patients [to] receive substandard care" (Berge, et al., 2012, pg. 674), often resulting in infection, injury, and even death.  Narcotics are the most commonly diverted drug class, either for personal use or financial gain.  The article suggests awareness as the best practice for detection and prevention.  It ends with a call to action for all facilities to develop standards to combat diversion.  A major strength of this article is the comprehensive nature of the research by a reputable organization, the Mayo Clinic.  It is also extremely relevant to my topic.  A weakness is the research was conducted in Mayo Clinic facilities, and may not translate specifically to drug diversion in a hospital setting.

The next article I chose for this post is one from Kentucky Nurse, a journal published by the Kentucky Nurses Association.  The article begins by discussing the high addiction rate among nurses.  The author posits that nurses may be at increased risk due to shift work, stressful situations, and easy access to drugs.  Like the Mayo Clinic article, Ivey (2015) relates that we must prevent diversion in order to "prevent substandard nursing practice" (pg. 9).  The article cites education as the best prevention; and suggests we utilize treatment, rather than punishment, as a deterrent/solution.  A strength of this article is that it shows the prevalence of substance abuse among nurses.  Having said that, a weakness is that it discusses substance abuse more than diversion.

The third article I chose to discuss is actually legal docuents of an actual case of a diverting nurse.  The State of Washington, Department of Health, published online the case files regarding diversion and substance abuse committed by a nurse named Cory Riehart.  Cory was issued a RN license in 2008, and was found to be diverting from several facilities in 2015.  In 2016, she was given the opportunity to keep her license active by entering a treatment program, which she subsequently failed.  Several drug tests came back positive and she arrived at an emergency department after breaking a needle in her arm while injecting heroin.  Her license was then suspended, and criminal charges were filed.  The strength of this source is that it shows how law enforcement and state boards are taking diversion, as well as how devastating the effects can be.  It also provides a real, specific example of the ongoing problem.  A weakness is that it is an example of only one incident, and does not provide insight into the scope of the issue.

The next article for this post is from the journal, Reflections on Leadership.  Although it is somewhat short, it provides good information.  The author recognizes diversion "is a breach of professional ethics, places patients at risk, and can affect the reputations of the facilities where they work" (Sigma Theta Tau International, 2014, para. 3).  The article also advises of some warning signs, including excessive wasting, often volunteering to administer medications to other nurses' patients, and discrepancies in medication administration documentation.  This article also suggests treatment for diverters, instead of discipline.  A strength of the article is the author cites credible sources, such as the ANA.  A weakness is that it does not appear to be comprehensive, failing to address the incidence of diversion.

I also chose for this discussion post, an article that is an excerpt from a book written by a diversion expert.  One interesting thing cited by the article is, "agency nurses are often implicated in drug diversion cases" (New, 2017, pg. 12).  The author vehemently encourages drug security and nurse responsibility to ensure patient safety.  Many institutions, including CMS, the DEA, FDA, EPA, CDC, and state boards of nursing also support responsibilty and accountability.  Because narcotic waste is a common way to divert drugs, the author suggests the development of policies and procedures to outline protocols for more secure wasting.  Other deterrence tactics include limiting dose and quanitity available, and increasing monitoring capabilities.  A strength of this article is it is written by an expert in the field; however, that can also be a weakness as experts are low on the hierarchy of levels of evidence.

The last article I chose for this post is an interview with the same expert that wrote the previously discussed article.  It is centered on how to prevent diversion.  The author says education is key, that we must first understand the risk is real, and we must be proactive.  Some suggestions for detecting diversion include monitoring, and testing waste.  Testing waste is considered best practice.  Prevention can occur by having receptacles that deactivate the drug as it is wasted.  The author suggests developing a diversion committee that includes departments such as pharmacy, HR, nursing, security, risk management, and employee health.  A root cause analysis should be conducted with all cases of diversion.  A strength of this article is that is specifically addresses ways to combat diversion.  A weakness is again, that it was written by an expert, and is not a systematic review.

 

Berge, K., Dillon, K., Sikkink, K., Taylor, K., and W. Lanier (2012). Diversion of drugs within health care facilities, a multiple-victim crime: Patterns of diversion, scope, consequences, detection, and prevention. Mayo Clinic Proceedings, 87(7): 674-682.

Ivey, M. (2015). Student spotlight: Substance abuse among nurses. Kentucky Nurse: 8-10. Kentucky Nurses Association.

New, K. (2017). Drug diversion prevention: Regulatory requirements and best practices. Healthcare Life Safety Compliance: 11-14. HCPro.

Q & A: Drug diversion prevention in your facility (2016). Briefings on Hospital Safety: 7-10. HCPro.

Sigma Theta Tau International (2014). Substance abuse occupational hazard for nurses. Reflections on Nursing Leadership, 40(3).

State of Washington, Department of Health (2016). Master Case M2016-370. Nursing Care Quality Assurance Commission.