Episode #116 Drug Diversion in the Anesthesia Environment

Hello and welcome back to the Anesthesia Patient Safety Podcast.  My name is Alli Bechtel, and I am your host. Thank you for joining us for another show. Today, we have some special content from a recent Chime Opioid Action Center Podcast. We are going to be hearing from Elizabeth Rebello, an APSF board member, and Dominic Carollo from Oschsner Health, who were recently interviewed for a Chime Opioid Action Center Podcast. The focus for the podcast is on why the OR and Procedural areas have unique challenges for monitoring for potential drug diversion.

Before we dive into the episode today, we’d like to recognize GE Healthcare, a major corporate supporter of APSF. GE Healthcare has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, GE Healthcare – we wouldn’t be able to do all that we do without you!.”

Before we take a listen to some of the Chime Podcast. We are heading over to APSF.org and checking out an article from our archives. Our featured article today is “Drug Diversion in the Anesthesia Profession: How Can the Anesthesia Patient Safety Foundation Help Everyone Be Safe?” by Maria van Pelt and colleagues. To follow along with us, head over to APSF.org and click on the Newsletter heading. Fifth one down is the Newsletter archives. Then scroll down to February 2019. From here, scroll down until you get to our featured article today. I will include a link in the show notes as well. This article is a report of an APSF conference dedicated to this topic. This is a threat to patient safety and health care professionals. The APSF is dedicated to this topic since substance use disorder, diversion in the workplace, and their potential adverse effects on patient safety require a commitment to the following: open discussion, education, research, policy, and other interventions that may be identified.

What is the scope of the problem? This is an important question since it is a significant occupational hazard with little forward progress towards decreasing prevalence, education, and outcomes. Back in 2019, it was estimated that 10-15% of health care workers will misuse drugs or alcohol during their career and this is one of the most disabling illnesses in healthcare workers.

This is a threat to safety that impacts so many people: patients, the healthcare professional and their coworkers, and employers. Patients are at risk since drug diversion means that drugs are diverted from the patients which they may need for appropriate pain control and blood-borne infectious outbreaks have occurred due to drug diversion. There have been several high profile cases of hepatitis C outbreaks in patients following drug diversion and tampering. Anesthesia professional must remain vigilant with narcotic medications and keep these in a secure location under direct control. Other risk management strategies for securing narcotics were provided by Brian Thomas and include the following:

• careful review and adherence to all hospital/facility drug storage and security policies
• never leave controlled substances or medications likely to be diverted unsecured and unsupervised
• consideration for keeping controlled substances or medications likely to be diverted on your person once dispensed
• report any suspicious behavior or activity if you suspect drug diversion
• Implement workplace drug testing policies

In the next section, Tricia Meyer reports on the why and how of drug diversion. Unfortunately, this is a common problem in the healthcare workplace for the following reasons: high-risk setting, easy access to drugs, self-medicating for personal health problems, cultural acceptance of pharmacological agents to cure ills, pain reduction, over work, sleep deprivation, availability and access, advanced parenteral administration skills, believed immunity to drug abuse, and exposure to death and dying. Drug diversion can occur at many points from procurement to preparation and dispensing to prescribing, to administration, and finally to waste and removal of the controlled substances. Hospitals and institutions are responsible for maintaining a controlled substance diversion prevention program in compliance with federal and state laws and regulations, but there are inconsistencies in these programs. Drug diversion continues to occur despite these programs due to poor accountability, inconsistent compliance with regulatory requirements, convenient processes with less control, inconsistent and delayed consequences, lax processes, and a culture that supports a reluctance to speak up. Hospitals can make a difference to stop diversion by using technology and ongoing surveillance to maintain procedure compliance and effectiveness.

For healthcare workers who are impaired, proper treatment should also include an accountability monitoring program to promote sustained sobriety rather than a punitive-only approach which has not been shown to work.

Check out Table 2 in the article for recommendations and possible interventions for health care facilities and health systems that was created following the conference in 2019. We are going to review it now.

1. Develop a prevention focus related to substance use disorder and diversion within health care organizations which may be facilitated by developing a Clinician Wellness Committee within the procedural practice.
2. Provide a comprehensive educational program related to substance use disorder to reduce the stigma associated with it and to promote a culture of safety.
3. Develop clear policies related to drug diversion and substance misuse. This may be supported by a multidisciplinary group to review best practices and develop policies for the prevention and detection of drug diversion and substance misuse in procedural practices; this should include a drug diversion team that investigates missing drug events.
4. Health care organizations should identify and provide appropriate recommendations related to “process of reporting” and treatment options for all anesthesia professionals. This may be done with an information tool kit and a designated resource person within the anesthesia department and health care organization.
5. Develop a comprehensive approach to managing the key areas of focus related to substance use disorder with annual competencies modules related to wellness, substance use disorder, diversion, and treatment options.
6. Develop a comprehensive and standardized requirement for new employee reference checks (including clarity on any gaps in employment).
7. Develop consistency across all health care institutions with a clear and well-defined policy for institutional oversight of controlled substances.
8. Prioritize compliance and accountability with standardized drug testing policies.
9. Intensify research and learn from all health care disciplines with multidisciplinary collaborations.

Now that we have reviewed the recommendations from 2019, let’s take a listen to a some of the CHIME Podcast now for an update. We are going to hear Rebello and Carollo share what their institutions are doing to help decrease drug diversion and why drug diversion is an important patient safety consideration with moderator Amanda Hays. Let’s take a listen now.

[CHIME podcast recording]

Thank you to CHIME for sharing this Opioid Action Center Podcast with us and I will include link to the full podcast as well in the show notes.

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.  The 2022 APSF Stoelting Conference just wrapped up, but the American Society of Anesthesiology Annual Meeting is right around the corner with several anesthesia patient safety talks including a wellness panel called “Wellness, Burnout and Resilience: New Wrinkles in Patient Safety” and the Ellison Peirce Lecture called “Racial and Ethnic Disparities in Perioperative Patient Safety” and the APSF panel on “Challenges in Non-Operating Room Anesthesia.” Head over to APSF.org and click on the Conferences and Events heading and the first one down is upcoming APSF events. Mark your calendars and we hope to see you there!

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2022, The Anesthesia Patient Safety Foundation