Expert Insights on New ASHP Drug Diversion Guidelines

Expert Interview

Patrick Yoder, PharmD, discusses the impacts of the impending ASHP guideline updates, how to build drug diversion processes, and the ways that technology can target drug diversion.

For more on the new guidelines on best practices for diversion detection, tune into this panel discussion, featuring diversion experts who will examine the problem of drug diversion and anticipated best practices for adhering to the pending guidelines.

Learn more about the webinar.

Drug Topics®: Hello, I'm Gabrielle Ientile for Drug Topics®. In this interview, I'll be speaking with Patrick Yoder, PharmD, founder and chief executive officer, LogicStream Health, about the issue of drug diversion and incoming updates to the American Society for Health-System Pharmacists (ASHP) set of guidelines for preventing drug diversion.

Patrick, can we start today with your professional background and expertise and the mission of LogicStream Health?

Yoder: Yeah, for sure. Thanks for having me, Gabby.

I'm a pharmacist by training, although I tell folks that maybe they shouldn't ask me hard drug questions anymore, because I haven't done that for – I haven't practiced as a pharmacist for quite some time. When I did practice, I was in critical care medicine mainly, so ICU care. Very sick patients.

But then I transitioned to health information technology as a real focus during the time when electronic health records were being implemented in this country, so 10 years ago or so. And had really stayed in that world and grew up as an entrepreneur. And started a company in that space, made a lot of sense, eventually. And so that's what led me to what I do today.

Drug Topics®: So today, we're talking about the issue of drug diversion. ASHP his updating their set of guidelines on preventing drug diversion. First, can you give us a little overview of these updates?

Yoder: Yeah, I think what we're seeing is that they're in the process of updating them, so we have some early insights into what the ASHP updates will be.

I think they last updated those guidelines in 2017, so a lot has changed since then. I think some of the things that we expect them to highlight and really add to those guidelines are a more comprehensive view of the potential spots of diversion in a health system, all the way from procurement of the drug to administration and waste, so something on the order of 1000 different places where drugs could be diverted.

We also expect them to recommend 100% review of transactions in that flow, from procurement to administration and waste, which is a large change from previously.

And then we expect some comments and commentary about newer technologies in this particular space. Examples might be automation, machine learning, artificial intelligence (AI), radio-frequency identification (RFID), probably some others as well.

Drug Topics®: And what do you see as some of the potential impacts of the new guidelines coming out?

Yoder: Yeah, I think it's interesting. I think health systems have more and more focus on this all the time. I think what we're going to see is, health systems continue that focus, but they don't have a huge amount of extra resources to do this.

And so, they're going to have to figure out new and creative ways to basically build out their diversion processes to match these new guidelines. I'm excited about them. I think, at the end of the day, diversion is about people and, in talking with our customers, it excites me a lot that they think about diversion not in like a policing type way or find the diverter and put them in jail, but more if we can prevent it and get ahead of it far enough, we can help those colleagues of ours get the help they need to basically solve that problem for them personally, if they're using drugs, and as part of their diversion activities.

Drug Topics®: From your experience in identifying, managing and preventing drug diversion, how can hospitals build effective diversion processes using proven best practices?

Yoder: I think that there's, well, there's a lot of things that they can do, and it's certainly not cookbook.

What we've seen from our work is that there's really 3 areas that tend to be the focus. Those are audit, consult and technology.

And the audit piece is really partnering with an independent third-party consultant or a contractor that has worked with lots of health systems and really looking at your current processes, your current people, your current committees. And the way that you do your diversion today. And basically, comparing that to what they've seen is as best practices across all of their customers and really developing gap analysis, so to speak, of what you should consider as a health system changing.

The consultant pieces really having that same party or another consultant work with your teams in parallel, so together with your diversion management committee, and actually work through filling in those gaps. Updating policies and procedures, making sure roles and responsibilities are really well defined.

And then the third part is technology. What we've what we believe is going to be part of the ASHP recommendations, and others as well, so it's not only ASHP that focus on this, but there are also certainly other organizations as well, including organizations like the joint commission that actually assess and accredit hospitals systems, is a recommendation to review all transactions. Technology is going to be a requirement in that world. Because today, what we know is, most hospitals actually spot check 10 or 20% of their transactions on a monthly basis. Going from that to 100% transaction review is just going to require new innovative automation technology, and, really, data to basically make all that happen much, much more efficiently so that health systems can actually achieve that goal.

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