This is our second article in a series of drug diversion topics. In our first article, we discussed culture, situational awareness and teamwork as important aspects of a drug diversion program. In this article, we will focus on monitoring and detection software as a robust tool in the diversion program.
Most automated dispensing cabinet (ADC) vendors have rudimentary software included at their main console to provide reporting on ADC utilization by individuals. “Utilization” typically translates to “withdrawals” from the ADC over a given timeframe and may report as either individual transactions or as standard deviations compared to the norm for all users of that ADC, or across all ADCs. Other software such as Pandora® and RxAuditor® have more robust reporting capabilities and analytics. These programs enable the end user to define report parameters and can drill down on virtually any activity at the ADC: withdraw, canceled remove, inventory, waste, witness waste, etc.
Now comes the important question: “What tools do you have in your diversion monitoring and detection program?”
Knowing which type of software you are dealing with may dictate other aspects of your monitoring and detection program. In our experience, the baseline software which resides on your ADC software platform typically is not ideal for organizations greater than 50 beds. Beyond that size facility, system complexities become challenging to adequately monitor and detect diversion. When we ask larger organizations using this type of baseline software “How many people are you catching,” the response is usually “1 or 2 per year.” Our experience indicates for a mid-sized hospital that number should be closer to 8 – 10. The reason we hear the aforementioned number is the lack of data and defined reports available to the end user, even if they are conscientiously monitoring.
Let’s consider the other scenario where you have the more robust software to monitor and detect diversion. You may find yourself data rich and information poor. Some key questions to consider:
- How many people understand and know how to use the monitoring and detecting software?
- Do you run “canned” reports and then simply email them out to Nursing?
- How do you monitor for “travelers” and other providers who float between patient care areas?
- How often do you run reports and adjust your parameters?
- Do you understand where each of the data points comes from?
It is not unusual for us to encounter an organization with the robust software installed and find out that “the person who was responsible for monitoring and using the software no longer works here” or that only one person actually knows how to use the software. This creates a single point failure risk for the organization. We have also spoken with pharmacies that simply send the reports to the nurse managers and rely on them to review the reports. During those same visits we often hear from nursing that they get the reports but have no idea how to interpret them. “Travelers” and “floaters” create additional challenges, even with robust software. Unless you have an active dialog with your Nursing Staffing Office, travelers and floaters will begin to blend in because they typically aren’t around any one ADC long enough to hit the top of the list.
Regarding report parameters and frequency, most hospitals are not organizationally static, by nature. Patient care units close or temporarily shut down for renovation, census fluctuates, and patient populations change. All of these factors should influence how you generate reports and what areas you may consider combining as one for monitoring. Knowing and understanding what data points are at work for the various reports is key to interpreting the results. Have you ever encountered someone removing the entire inventory of a narcotic from the ADC drawer and then find yourself in a panic? As you begin running reports and go to the unit, you learn that the next transaction was a nurse returning the entire quantity to the ADC drawer because s/he incorrectly performed the blind count function. This is not a bad outcome, but it makes you stop and consider where the numbers come from in your reports. Also, looking at “withdrawals” is not the only transaction type you should be reviewing. We mentioned several before and they are worth mentioning again: withdraw, canceled remove, inventory, waste, and witness waste.
At Visante, we believe in a comprehensive drug diversion program utilizing robust software as a tool for monitoring and detection. Building in redundancy, having a multidisciplinary approach and awareness of the ever changing environment will help you and your organization minimize diversion risk. Given recent headlines and organizational fines, many organizations are considering an external review of their drug diversion program which includes a review of what tools they have for monitoring and detection. Having the right software and knowing how to use it is a great start.