Approximately 10% of all U.S. healthcare workers will divert opioids or other controlled substances from their workplace at some point in their career.1 Drug diversion, or the illegal distribution or abuse of prescription drugs, remains a top challenge at hospitals and health systems across the country, and is often undiscovered and underreported.2

Steve Wenger, Inpatient Pharmacy Manager at Rady Children's Hospital in San Diego, California, still recalls his shock when a backed-up sewer line was found to have been clogged by syringes and fentanyl vials. “We had some open trash cans in the operating room and discovered that someone had been stealing partial doses of fentanyl out of them,” he said.

In the past, determining where those vials had been diverted from and the person or persons responsible would have required hours of pharmacy staff time to investigate. However, Rady Children’s Hospital had already implemented radio frequency identification (RFID) medication management technologies, which helped Wenger’s team easily locate where the vials had been originally placed so they could focus their investigation and implement solutions to prevent future issues.

“Having these systems let us know that we had to switch out our waste systems so this kind of diversion couldn’t happen anymore,” he added.

Manual counts and intense documentation efforts

Historically, pharmacists and pharmacy technicians spent a substantial part of their day manually logging the controlled medications used throughout the hospital. They were required to perform physical counts of opioids and other restricted substances multiple times a day while also maintaining all corresponding documentation to track where those drugs resided in the facility. Christa Miller, Senior Pharmacy Manager at AdventHealth in Orlando, Florida, said that those manual processes were time consuming, but became even more so whenever they found a discrepancy.

“When we see that our Dilaudid count is off by one, we need to figure out what happened,” she said. “Did a nurse accidentally grab two vials instead of one? Did the vial fall between the cabinet drawers? Or was it diversion?”

She recalled one instance in which the team had to complete three separate physical searches of the narcotics vault, requiring multiple staff members to be present, before realizing that the item in question had been misplaced.

The addition of RFID medication management solutions such as narcotic vaults, anesthesia control systems, cabinets and refrigerators has helped immensely, according to Miller. But the addition of manufacturer-enabled RFID medications could bring further efficiencies to controlled substance management. “You would be able to see, immediately, that something has gone missing without having to physically inspect the machine or safe,” she noted.

In cases in which diverters might adulterate a drug or replace it with something else, having RFID-tagged medications would also help Miller’s team to investigate an issue before patient safety was put at risk.

“You could see that someone went into the pocket, removed 10 vials and then replaced them 10 minutes later,” she said. “Those flags could help us move a lot faster in our diversion investigations, as well as help prevent diversion because people would know we would have a clearer window into what they are doing.”

Preventing controlled substance diversion requires a comprehensive approach

Both Wenger and Miller agree that RFID medication management solutions have already improved their teams’ ability to read, count and document medications and their movement across facilities. Manufacturer-enabled RFID medications could further streamline their monitoring and investigative processes.

“It would be like automatically scanning items at a grocery store,” Wenger pointed out. “You could push the anesthesia or emergency tray through the RFID reader, and it would give you a printout of everything that’s inside, including the expiration dates and lot numbers, without having to tag and scan every medication.”

This would not only save staff considerable amounts of time but would also help avoid manual errors that might make it easier for a drug to be diverted or tampered with once it leaves the pharmacy. Miller believes such a future is possible if drug manufacturers and medication management solution providers come together to create it.

“If our controlled substances all came with RFID tags and our safes and narcotic vaults were all RFID-enabled, we would be able to see if there’s an issue without having to spend hours counting,” she said. “When we can quickly figure out if it was a diversion or medication error, we can accelerate our investigations. And, in the process, we will increase efficiency and safety.”

For stories and perspectives from industry thought leaders exploring how RFID technology and innovation advance healthcare, visit https://www.plusrfid.com/insights/.

References

1. Healthcare Diversion Network. https://healthcarediversion.org/.

2. Knight, T., May, B., Tyson, D., McAuley, S., Letzkus, P., and Enright, S. 2022. Detecting drug diversion in health-system data using machine learning and advanced analytics. American Journal of Health System Pharmacy 79(16):1345-1354. August 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353695/.

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