Managing Drug Diversion Amid Pandemic

August 10, 2020

The COVID-19 crisis poses unique challenges for managing controlled substances in hospitals.

In a webinar offered by Becton, Dickinson and Company (BD), experts focused on provider collaboration in managing drug diversion amid the novel coronavirus disease 2019 (COVID-19) pandemic.1

Presenters from BD—W. Perry Flowers, MS, RPh, vice president of medical affairs, enterprise medication management; Kelly Robke, MBA, MS, RN, vice president of thought leadership, medical affairs; and Doina Dumitru, PharmD, MBA, FASHP, senior director of medical affairs—emphasized that cross-clinical collaborative effort, including collaboration with pharmacists, needs to be part of the solution to drug diversion.1,2

Robke explained that the pressures of the pandemic exacerbate what the presenters referred to as “health care’s hidden pandemic,” in which injured, stressed, or overworked health care workers are vulnerable to substance disorder.1

The primary stress drivers in hos- pitals include short staffing (74%), emotional demands (67%), long hours (60%), and patient volume (60%). Robke identified factors aggravated by the pandemic; for example, as hospitals experience decreases in available staff, many nurses are taking care of more patients than they usually do.1

Opioid misuse can occur when health care workers use readily available drugs to “relieve” occupation-related pain, including that from strenuous work and long hours on your feet, as well as stress.“We hear frequently and consistently stories of stress [related to] the crisis and are aware that many clinicians are faced with a substantial amount of burdens outside of [those] typical of care delivery,” Robke said during the webinar.1

According to Robke, effective strategies for minimizing drug diversion include as follows:

  • formal training,
  • roundtables and informal peer discussion,
  • comprehensive surveillance programs,
  • more accurate data, and
  • access to a rehabilitation pathway.

Current developments could facilitate opioid misuse, according to Dumitru: “As the COVID-19 pandemic has evolved, the impact on health care capacity has created surges in the key medication management areas that have challenged providers in ways unseen before.”1

Dumitru explained that rapid deployment of drugs in hospitals— through relaxing or deferring of normal controlled substances processes to accommodate surging needs in new locations—presents an opportunity for diversion. "With the opioid crisis still deeply affecting our country, statistics tell us that diversion will happen in these search settings, potentially with greater frequency than in regular care settings. This makes managing controlled substances an even more challenging operational process than usual, especially if new areas have more access that provides new opportunities in the context of different security procedures,” she said.1

With the pandemic bringing in a surge of patients and, subsequently, more variety of narcotics available on the floor, hospitals need to implement collaborative strategies.1,2

“Nursing needs to play a role and really respect the role that [pharmacists] have in the cross-clinical collaborative effort in being a part of the solution,” Robke said.“The most predominant step... is to be partners with our pharmacy colleagues, with our IT [information technology] and informatics colleagues, not only so that we act together...to allow us to comply with standardized workflows that I mentioned previously around medication, but we also need to assume our leadership responsibilities here as patient care leaders.”1

References:

  1. Flowers WP, Robke K, Dumitru D. Managing drug diversion during a pandemic. Becton, Dickinson and Company. Webinar. June 16, 2020. Accessed June 16, 2020. https://www.bd.com/en-us/clinical-excellence/bd-institute-for-medication-management-excellence?utm_source=OTR&utm_medium=OTR&utm_content=DI7404_Van_Jan17&utm_campaign=7010L000000F71I
  2. Flowers, P, Robke, K. Health Care’s Hidden Epidemic A Call to Action on Hospital Drug Diversion. BD; 2019. https://www.pahomepage.com/wp-content/uploads/sites/91/2019/06/BD20Diversion20Health20CareE28099s20Hidden20Epidemic20-20Research20Report2005-201920_OP_1_CP__1559762394113_90867805_ver1.0-1.pdf.
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