Transcript Development of a Road Map to Controlled Substance

Development of a Road Map to
Controlled Substance Diversion
Prevention
Rene Cronquist, RN, J.D.
Director of Practice and Policy
Minnesota Board of Nursing
In the news….
“Prison Sought for Nurse Who
Stole Drugs”
“Nurse Accused of Stealing
Patient’s Prescription”
“Nurse Pleads Guilty to Stealing
Narcotics from Patients”
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
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.
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).
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)
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).
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.
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
Prevention Roadmap Outline
• “SAFE” infrastructure
• Best Practices Principles
• Tool Kit
“SAFE”
•
•
•
•
S: Safety teams/Organizational structure
A: Access to information
F: Facility expectations
E: Educate staff and patients
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
Best Practices
•
•
•
•
•
•
•
Procurement
Storage and security
Prescribing
Preparation and dispensing
Administration of CS
Handling wastage
Follow-up if diversion is suspected
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
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)
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
Next steps
• Disseminate
information
• Encourage adoption of
best practices
• Continued
communication among
coalition members
• Measure effectiveness
• Develop tools for other
healthcare settings
Report, Roadmap and Toolkit
http://www.mnhospitals.org/inc/data/drug-diversion-toolkit/drugdiversion-final-report-March2012.pdf
http://www.mnhospitals.org/inc/data/drug-diversiontoolkit/controlled-substance-diversion-prevention-roadmap.pdf
The Minnesota Hospital Association - Controlled Substance Diversion
Toolkit
All of the above will soon be posted on Board’s website:
www.NursingBoard.state.mn.us