Drug diversion, a series: how to deal with it – Guest Columns

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Norris Cunningham

In the first part of this series, we discussed drug diversion: what it is, how to prevent it and how to detect it. This column will focus on how to investigate drug diversion.

When drug diversion is suspected or has been reported in your facility, you must act quickly and decisively to conduct a detailed and thorough investigation. Most importantly, facilities must ensure that they meet all local, state and federal reporting obligations.

Internal investigation

A detailed and thorough investigation is imperative to report a suspected diversion, as incomplete investigation and follow-up can have serious consequences for patient care, legal and compliance. Although facility management and area supervisors where a diversion is suspected will assist in the investigation, an outside legal advisor should be involved to ensure that bias does not influence the investigation.

Steps in an Appropriate Investigation

First, determine if the diversion is isolated or significant. Any unresolved discrepancy should be viewed as a possible diversion and should be investigated. If it is important, a root cause analysis and a recommendations approach should be undertaken to prevent future hijackings.

Next, create a standardized process for interviewing suspected diverters of controlled substances. Out of prudence, the suspension of any deviators should be undertaken and the revocation of their login credentials for the electronic medical record as well as the automated distribution unit should take place as soon as possible. Develop questions to reveal the hijacker’s drug of choice, when it started, its method (s) of diversion, location (s) where the diversion occurred, what records were / were not were not kept and an estimate of the amount of drug loss.

Angela Rinehart

In addition to interviewing the suspected deviator, a standardized process for interviewing patients potentially affected by the diversion should also be conducted. In addition, a defined process for internal and external reporting of drug diversion incidents is required.

Next, the facility should perform a systems analysis of controlled substances processes, including failure modes and effects, to identify risk points in order to take action to improve diversion prevention. Collect key documents needed to conduct a thorough investigation and create separate records for investigation and quality assurance.

Review the records of the suspected hijacker (s) to determine if the drug count reveals a loss or if the drugs were administered without an approved prescription. Confirm via an in-depth audit carried out either by an external legal advisor or by the director of the control substance diversion prevention program, that the diversion by the management of the establishment (director of nursing, head of unit, etc. .) did not happen. Confirm that the drug test took place and the result and create a final report of the diversion incident.

Regulatory investigation

In addition to the internal investigation into suspicion of hijacking, a regulatory investigation is inevitable. As such, the facilities should be prepared for the standard documents and information requested by regulatory bodies in the event of drug diversion.

Regulatory authorities will want to know the date (s) of each diversion, identification of residents whose drugs were diverted, drugs diverted, the amount of drugs diverted, and the dollar value of each drug diverted. Additionally, any medications paid for by Medicare or Medicaid could have implications for overpayments under applicable payment rules and laws. Institutions will want to discuss these matters in depth with legal counsel. Regulators will also want to know if surveillance video is available, how long the video is available before the system is crashed, and if surveillance video is being monitored. It is recommended that facilities put all surveillance video and documentation on legal hold as soon as a hijacking incident is suspected.

John myers

Regarding documentation, authorities will generally request the medical or electronic health record of the resident (s) concerned, including, but not limited to, admission records / cover sheets, doctor’s orders for drugs / prescription summaries, drug administration records / eMAR during the period of suspected diversion, controlled substance count records, drug disposal records / drug disposal records, notes nurses, pain and pain symptoms, risk care plans, pain assessment ADUs / pain monitoring tools / pain assessment forms, resident behavior records and the mood of residents for MDS.

“The investigation file, including the Ministry of Health incident report, staff interviews and statements, chronology of events, investigation / risk report verification, interviews with residents and the summary report of the meetings / during the service, will also be requested.

In summary, when a hijacking is suspected, investigations should be carried out as thoroughly and completely as possible and reports should be carried out in accordance with laws and regulations. Having standardized processes in place will make it easier to navigate diversion investigations.

Norris Cunningham is a founding shareholder and leads the healthcare practice group at Katz Korin Cunningham PC (KKC) in Indianapolis. Contact him at [email protected].

Angela Rinehart is Associate Lawyer in the KKC Healthcare Practice Group and focuses her practice on the advocacy of long-term care providers. Contact her at [email protected].

John myers is the Director of Litigation Support for KKC and has extensive litigation experience and technical assistance in all aspects of litigation. Contact him at [email protected].

The opinions expressed in McKnight Long Term Care News guest submissions are those of the author and not necessarily those of McKnight Long Term Care News or its editors.

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