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How to stop drug thefts in ten “easy” steps (aka: diversions)

By Doug Beardsley, Vice President of Member Services
November 9, 2018  |  All providers


Each year, there are approximately 50 substantiated drug theft findings (aka: exploitation—medication diversion) in Minnesota’s skilled nursing facilities, nursing facilities, and home health providers. And those are only the medication thefts that are identified, reported to OHFC and/or MARRC, investigated, and substantiated for exploitation!

A Care Providers of Minnesota review of recent drug thefts from long-term care communities, combined with feedback received from members during our recent Region Forums, helped to  identify ten very specific measures providers can implement that would help prevent, minimize, or catch such drug thefts. Have you implemented these best practices?

1. Audit the use of prn narcotics. The most common technique for staff to steal narcotics is to utilize authorized prn narcotic orders (usually ordered for breakthrough pain or pain uncontrolled with scheduled medications). Does one staff member identify the need for prn narcotics more than other staff members? Can you verify that your residents or clients are getting the prn narcotics that are signed out as administered? Routinely audit to see if you have any outliers “administering” prn narcotics—if so, investigate!
2. Count narcotics at the beginning and end of every shift. This will help hold staff accountable, protect staff from accusations of theft, and shorten up the period of time for investigations if shortages are identified. Consider adding gabapentin (Neurontin®), Fioricet®, medical cannabis, Ritalin®, Concerta®, Adderall®, Dexedrine®, Wellbutrin®, and CNS depressants such as Ambien®, Lunesta®, and Sonata® to your drug counts. 
3. When counting narcotics, if blister cards are used for medication storage, verify that the integrity of the blister cards are intact. Drug thieves are using two techniques: (1) cutting the foil seals, and (2) un-heat sealing the entire backside of the cards, then taking the narcotics, replacing the stolen pills with look-alike pills, followed by a resealing of the backside. Verify the integrity of the cards and the accuracy of the pills inside the cards.
4. Don’t stockpile discontinued or expired narcotics. If you know the cupboard or file cabinet drawer is full of narcotics awaiting destruction, others are also aware of that. The larger the stockpile is, the better the target and the longer it will take you to discover missing narcotics. What is your policy for timeliness of medication destruction, and are you following it?
5. Audit for drug loss. Does one particular staff member drop, waste, or spoil more narcotics than others? If an outlier is identified, investigate.
6. Verify the status of fentanyl patches. Are they applied correctly and verified daily? Do some staff claim the patches are falling off more than others, requiring replacement patches? Do you need to secure the patches better (first aid tape, Bioclusive™, or Tegaderm™)? Are used patches destroyed with a witness by cutting them up (gloved) and sewering/flushing?
7. Verify co-signatures or initials on drug destruction documents. Have both staff on drug destruction documentation verify that they witnessed the destruction. Avoid having the same two persons always co-witness the destructions. Nurses may find fellow nurses have been forging their signature or initials as a witness to drug destruction.
8. Tighten up who can receive drugs delivered from the pharmacy and where newly received drugs are dropped off. Can a delivery simply be left at the front desk or nursing station? Can persons other than qualified staff accept delivery of medications? There have been instances where the drugs dropped off at the nursing station or front desk simply disappeared. 
9. Watch for job-hopping when looking for new staff. It can take law enforcement, certifying agencies, and licensing agencies a long time to “catch up” with a drug thief. Someone you terminate from employment for suspected or confirmed drug diversion could get hired 3-4 more times by other employers before the system catches up with them.
10. Monitor for unusual staff behavior. Is someone falling asleep on the job, easily distracted, sweating a lot, or exhibiting other unusual behaviors? This may indicate they are under the influence of the drugs they have stolen from you or your residents/clients. Is someone requesting to work on shifts with less oversight or in areas of the building that have more narcotics prescribed? This may indicate they want easier access to narcotics.

Implementing these ten measures will go a long way to helping prevent or minimize drug thefts, and if thefts do occur, you will identify the situation earlier in the process.

Also consider attending the following educational breakout sessions at our upcoming convention:

• Session 210: Keys to Effective Medication Management in Long-Term Care (11-12-18 at 1:45 AM)
• Session 310: Drug Diversion and the Opioid Crisis (11-12-18 at 3:00 PM)
• Session 404: Medication Management and Deprescribing (11-13-18 at 9:00 AM)
• Session 412: Intersection Between Nursing License Law and Criminal Law (11-13-18 at 9:00 AM)
• Session 706: Assessment and Management of Pain (11-14-18 at 8:30 AM)
• Session 811: OHFC Maltreatment Investigations and Progress Update (11-14-18 at 9:45 AM)
• Session 902: Opioid Use and Drug Diversion in Post-Acute Care (11-14-18 at 11:00 AM)

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Doug Beardsley  |  Vice President of Member Services  |   dbeardsl@careproviders.org  |  952-851-2489

 

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