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Drug Diversion Defined: Steps to Prevent, Detect, and Respond to Drug Diversion in Facilities

Categories: Healthcare-associated infections, Injection Safety

Injection Safety

Injection Safety

Guest Author: Kimberly New, JD BSN RN,
President, Tennessee Chapter of the National
Association of Drug Diversion Investigators

In my last blog, I talked about the impact of drug diversion on hospitals and healthcare facilities. Today, I will be discussing the frequency of diversion within healthcare facilities and what facilities can do to prevent, detect, and appropriately respond to diversion.

There are no reliable statistics about diversion by healthcare providers. This is because diversion is done covertly, and methods in place in many institutions leave cases undetected or unreported. At a facility with a strong diversion program and a nursing staff of about 1,000, I identified 1-2 new cases of staff members diverting each month. Well over 50% of those caught were diverting and using injectable opioids.

Diversion of controlled substances happens at all institutions. Because diversion can’t be stopped entirely, facilities must prevent it to the extent they can, identify cases quickly, and respond appropriately.

The essential elements of a healthcare facility diversion program include

  • Policies to prevent, detect, and properly report diversion,
  • A method of observing processes and auditing drug transaction data for diversion,
  • Prompt attention to suspicious audit results,
  • A collaborative relationship with public health and regulatory officials, and
  • Diversion education for all staff. 

In conjunction with its investigation of a diversion incident, the New Hampshire Department of Health and Human Services observed, “Highly educated and well-trained staff failed to recognize or overlooked behaviors indicative of addiction…or failed to follow established policies to address staff with substance abuse problems.” Ensuring that all staff are aware of the signs of diversion and impairment, and that they know reporting avenues, can facilitate quick recognition and response.

Whenever diversion is identified, healthcare facilities should promptly report to appropriate enforcement agencies and, ideally, obtain complete details from anyone caught diverting.  If injectable medications were diverted and tampering is suspected, facilities should also engage public health officials to assess the need for patient notification.

Drug Diversion Defined: Consequences for Hospitals and Other Healthcare Facilities

Categories: Healthcare-associated infections, Injection Safety

Kimberly New, JD BSN RN

Kimberly New, JD BSN RN

Guest Author: Kimberly New, JD BSN RN
President, Tennessee Chapter of the
National Association of Drug Diversion Investigators

In my last blog, I talked about how drug diversion, or theft of medication, poses a continuous threat to patient safety. In today’s blog, I’ll be discussing the many ways in which drug diversion negatively affects hospitals. It’s hard to believe, but drug diversion occurs in facilities every day.

Hospitals and other healthcare facilities are required to provide care in a safe setting and protect patients from harm. Diversion by personnel in healthcare facilities not only threatens patients, but also places the facility at risk. As a result of a diversion event, the facility can incur civil and regulatory liability, become the subject of negative publicity, and even be placed in “immediate jeopardy” of being shut down.

All healthcare facilities intend to provide good care, but many do not appreciate the frequency with which diversion occurs. They trust their employees to do the right thing. It is unimaginable that an employee’s addiction would go undetected or that a diverter would harm a patient. Facilities may view events as isolated occurrences, and be unsure of what to do once diversion is discovered.

Drug Diversion Defined: A Patient Safety Threat

Categories: Healthcare-associated infections, Injection Safety

Kimberly New, JD BSN RN

Kimberly New, JD BSN RN

Guest Author: Kimberly New, JD BSN RN
President, Tennessee Chapter of the National Association of Drug Diversion Investigators

You may have seen some recent media reports about drug diversion. Today, I want to break down the issue of drug diversion and provide some details about this serious patient safety threat.

Drug diversion, or theft of drugs, by healthcare personnel poses a continuous threat to patient safety in any healthcare setting in which controlled substances are handled. Although personnel who divert originally went into healthcare to care for patients, they have made poor choices for which they are accountable, including the impact their actions have on others. The longer a healthcare worker is allowed to steal medication, the greater the consequences become. Impaired providers can harm patients by providing sub-standard care, denying medications to patients, or exposing patients to tainted substances.

Tampering is the worst type of diversion. Commonly, the diverter removes medication from a syringe, vial, or other container and injects him- or herself with the medication. The diverter then replaces the stolen medication with saline or sterile water, or another clear medication or liquid. The “replacement liquid” is later used on the patient by an unaware provider. When tampering, the diverter may rarely use sterile technique. Ultimately the patient doesn’t receive the required medication and may be exposed to the diverter’s blood.

Outbreaks Highlight Infection Risks Associated with Drug Diversion

Categories: Injection Safety

Joseph Perz, DrPH, MA

Joseph Perz, DrPH, MA

Author: Joseph Perz, DrPH, MA
Quality Standards and Safety Team Leader
for the Division of Healthcare Quality Promotion,
Centers for Disease Control and Prevention

When prescription medicines are stolen or used illegally, it is called drug diversion.

Prescription opioid addiction has reached epidemic proportions and is a major driver of drug diversion. One aspect of drug diversion that is not well recognized involves healthcare personnel who steal controlled substances for their personal use. Under these circumstances, patient harm can take many forms. These include:

  • Substandard care delivered by an impaired healthcare provider,
  • Denial of essential pain medication or therapy, or
  • Risks of infection (hepatitis C virus, hepatitis B virus, HIV, bacterial infection) if a provider tampers with injectable drugs.

A Patient Speaks from the Heart

Categories: Healthcare-associated infections, Injection Safety

Karen Morrow

Karen Morrow

Guest Author: Karen Morrow

Like any other tragedy, the first thing to enter a person’s mind is, “This can’t be happening to me.”  It’s exactly what I thought.  I absolutely knew that I was OK…until I read the test results.  I still go back and read them now and can’t believe they are mine.  Writing this now, I am crying.  Even after all this time, it is still just so unbelievable to me.

I was one of the patients notified that I might be at risk for serious disease during the 2008 hepatitis C outbreak in Las Vegas.  Unbelievably, I tested positive for hepatitis C.  I followed the CDC’s recommended course of treatment, which was 48 weeks of both interferon and ribavin.  This regimen itself brought on a plethora of symptoms, some of which were nausea, insomnia, hair loss, exhaustion, muscle aches and pains, diarrhea and constipation.   Throughout the recent criminal trial involving my healthcare provider, I would go and sit in the courtroom every afternoon after work to listen.  I was sick at my stomach and nervous as hell, but I needed to be there.  Words fail me sometimes at the situation in which I find myself.  My whole life I have been a good girl:  absolutely no risky behaviors.  But I am a totally different person today than I was the moment before I received that call from my doctor’s office.

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