In a recent article, it was announced that the American Society of Health-System Pharmacists (ASHP) is planning to update the ASHP Guidelines on Preventing Diversion of Controlled Substances during the 2021-2022 timeframe. These updated guidelines will aim to assist hospitals in executing the best ways for incorporating the use of newer technologies into their institutional practices. Examples of technologies that may curb drug diversion include a machine-learning algorithm that looks past standard deviations to detect anomalous behaviors and aid users to correctly conclude investigation; a radio-frequency-identification (RFID)–automated medication management cart with end-to-end visibility of usable and end-of-life cycle medication; and vials with embedded RFID labels.

In the article about the upcoming updated ASHP guidelines, David Chen, MBA, BSPharm, the assistant vice president for pharmacy leadership and planning at ASHP, stated, “Our new version will review and evaluate market improvements” targeting diversion from many angles. He added, “The updated guidelines from ASHP aim to address 1,000 points across a hospital where diversion could happen, from procurement to preparation and dispensing, to prescribing, administration and waste removal. Every time you implement a process or tech-driven solution, someone figures out a potential way around it.”

The article also indicated that Massachusetts General Hospital (MGH) in Boston and Children’s Mercy Hospital, Kansas City, Missouri, are two institutions on the cutting edge of such antidiversion endeavors. At MGH, Christopher Fortier, PharmD, the chief pharmacy officer, stated, “Added difficulties of caring for COVID-19 patients drove higher diversion surveillance efforts overall.” Those efforts included an inventory audit following the hospital’s springtime surge “to ensure we accounted for the increased amounts of controlled substances we had to purchase” to care for the sickest COVID-19 patients.

MGH’s annual mid-year audit focused on fentanyl, hydromorphone, lorazepam, methadone, midazolam, morphine, and oxycodone.

In the interview, it was revealed that even though many factors may drive diversion, there are a few probable reasons. Dr. Fortier noted,  “During the first COVID-19 surge last year, MGH had to make rapid adjustments to workflow and other key operations.” For example, he said, “We converted general care units to ICUs, and needed nurses and physicians who don’t normally work in the ICU to staff those areas. Such changes could contribute to breakdowns in the normal checks against diversion. Coupled with the added stress on health care practitioners, these factors could explain why institutions have seen more discrepancies and overrides for controlled substances.”

The article also highlighted the insight of Brian C. O’Neal, PharmD, who assisted in the draft of ASHP’s initial guidelines to reduce drug diversion. Dr. O’Neal has implemented many of those top methods into practice at Children’s Mercy Hospital, where he serves as the senior director of pharmacy and biomedical engineering. He elucidated the fundamental elements of the hospital’s program, which include an interdisciplinary controlled-substance oversight council; an internally developed controlled-substance handling dashboard; overhead cameras positioned by all areas that contain controlled substances; and a satellite pharmacy within one of its two operating rooms that diminishes waste procedures so that “All controlled substances are returned to the OR pharmacy, where the anesthesia provider turns them in and watches with the pharmacist as they reconcile what was dispensed to them minus what came back.”

Dr. Michael Campbell PharmD, MBA, director of pharmacy services at Pomona Valley Hospital Medical Center in Pomona, California, emphasized the association between the stressors of the pandemic and drug diversion. He stated, “Pharmacy workflow modifications made during a pandemic, such as those aimed at reducing virus spread, conserving personal protective equipment and limiting employee exposure to infection, can increase the risk for diverting behavior.”

Dr. Campbell also remarked that using software guideline solutions can be a valuable resource since they require users to complete steps to close transactions of controlled substances and also alert the institution to any staff members who may require added training.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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