Better handling processes can help reduce risk of drug diversion

Drug diversion is a serious problem in healthcare systems, but the most vulnerable areas with the greatest risk of diversion in a pharmacy's drug-handling process may not be the ones that pharmacists think of first. The areas in the chain of custody where larger amounts of drugs can be diverted may be those that are taken for granted and where there are fewer electronic controls and monitors in place.

"People who are intent [on diversion] are working way harder at succeeding than you are at preventing it," Jones said. He discussed ways to prevent diversion from inside the pharmacy in a talk at the American Society of Health-System Pharmacists Midyear Clinical Meeting.

The best first step in finding out a system's vulnerabilities is to have a team perform a risk analysis on the pharmacy and all of its practices. This team should include people from outside the pharmacy system. "They don't have a preconceived notion of what the process is. They look at everything with the same unbiased view," Jones said. "Someone inside the process thinks the process is strong."

These outside advisors could be buyers or finance people who know a bit about the day-to-day operations, but who aren't part of it, he added. People inside the system tend to concentrate on the parts that are already more secure, such as drug safes and unit dispensing cabinets, he said, adding that diversion of drugs from a safe or monitored cabinet might involve only a few pills. Thefts at other points in the system might net large amounts.