Support Diversion Prevention From Purchasing to Disposal

You’ll see more efforts to reduce controlled substance diversion...due to new guidelines on prevention strategies.

Hospital staff have similar rates of substance misuse as the general population...but access is a big difference. Misuse impairs staff, puts patients at risk, and opens hospitals up to liability.

Support diversion prevention...from med purchasing to disposal. Success depends on a committed and vigilant team.

Ensure checks and balances. For instance, a person ordering controlled meds shouldn’t check them in.

Inspect controlled meds for signs of tampering...when receiving, dispensing, returning to the pharmacy, etc.

Don’t leave controlled meds unattended in ANY location...including the IV room or non-sterile compounding areas.

Use locked-lidded pockets when placing controlled meds in automated dispensing cabinets (ADCs)...to account for every transaction.

Follow the adage, “If it isn’t documented, it didn’t happen.” Chain of custody is critical...for delivering, wasting, etc.

To witness waste, verify med and amount...and watch the person dispose of the med so that it can’t be retrieved.

Anticipate monitoring and surveillance...cameras in the vault and other high-risk areas, random checks, etc.

Resolve your controlled med discrepancies ASAP...by the end of your shift at the latest.

Help close loopholes that may be overlooked when there’s a new product, a new patient care unit, etc.

For example, if a non-formulary med is ordered, check if it’s controlled. If it is, ensure it’s secured.

Keep in mind, staff who divert can get VERY good at it.

Watch for red flags...such as frequent packaging issues (broken vials, leaky syringes, etc) or coming in early or staying late in areas with controlled meds.

Stay alert for signs of misuse...such as confusion, decline in appearance, elaborate excuses, or severe mood swings.

Speak up about any concerns. Hospitals must have anonymous ways to report...and there can’t be retaliation against you. You may save a life...and the colleague can get the help they need.

Learn about other strategies with our resource, Controlled Substances Basics...and our PTU Elite: Controlled Substances & Diversion training program.

Key References

  • https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/preventing-diversion-of-controlled-substances.pdf (10-27-22)
  • https://www.jointcommission.org/-/media/tjc/newsletters/quick_safety_drug_diversion_final2pdf.pdf (10-27-22)
  • J Pharm Technol. 2020 Oct;36(5):211-217
  • J Am Pharm Assoc (2003). 2018 May-Jun;58(3):275-280
Hospital Pharmacy Technician's Letter. November 2022, No. 381111



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