Recent media reports highlight the problem of drug diversion by EMS and other healthcare workers.
A technician in a cardiac catheterization lab in New Hampshire allegedly infected more than 30 people with Hepatitis C after injecting himself with painkillers and placing the contaminated medication vial back into the drug inventory.
Authorities in Boston believe that over a six week period in summer 2011, a city paramedic may have injected himself with painkillers, narcotics and sedatives intended for patients, potentially exposing 64 patients to the risk of contracting a blood borne illness.
Drug diversion involves taking drugs intended for lawful use and transferring them to an unlawful channel of distribution or use. EMS personnel who suspect another employee of drug diversion have a legal obligation to report those suspicions to their employer (1). Failure to do so could result in the suspicious employee losing the ability to work in a drug security area.
Although not foolproof, technology may offer some assistance in reducing drug diversion by EMS personnel. One of the simplest forms of accountability includes drug storage practices that utilize some form of tamper-evident system.
Companies such as Healthmark and EM Innovations offer locking tags that allow agencies to secure drug kits or pouches that make it virtually impossible for others to access the drugs without breaking the tag.
Some versions come with a tab for the user to sign, which identifies the last person to have access to the contents; Narcotic Tamper Evident Bags feature a bar-coded plastic that distorts during any attempt to open it.
The bag also contains several safety features that prevent unauthorized users from cutting and attempting to reseal the bag unnoticed. These bags permit tracking throughout their life cycle in the EMS system.
CompX manufactures a locking mechanism that EMS administrators can mount onto exiting cabinets. Paramedics can open the locking mechanism using a personal identification number, a magstripe ID card, or a proximity ID card.
Other companies manufacture heavy duty steel or aluminum locking boxes that can be mounted in an ambulance or fire truck. Some versions, such as those made by Response Technologies, consist of a locking steel sleeve that fits inside a locking steel container mounted in the vehicle.
With this system, paramedics can unlock the container and remove only the locked sleeve containing the drugs they will need for that particular call.
Other systems, such as those made by Dean Safe, allow an EMS agency to assign a unique code to every person authorized to access the contents. The system’s memory stores the data in an encrypted file that is available only to the individual with the password. With this system, administrators can use computerized software to track every entry into the locked box.
Meanwhile, The Knox MedVault allows access only to individuals who are on duty with an additional security feature of requiring two PIN entries before granting access. MedixSafe’s Narcotics Cabinets require biometric data, such as fingerprints before opening.
Regardless of how foolproof one believes their technological protection to be, every EMS agency must have a strong quality improvement and audit program (2).
EMS administrators and medical directors both have a responsibility to conduct random audits of drug inventory logs and patient care reports, especially for patients who received a controlled substance.
Quality improvement managers should watch for trends in controlled substance administration. Individual inventory control or resupply personnel associated with a high number of broken vial reports should be a cause for concern.
Individual paramedics who administer significantly more controlled substances than others should also trigger an investigation.
Law enforcement officials are recognizing drug diversion in EMS with increasing frequency. Because there is no single agency or oversight committee for reporting, the scope of drug diversion in EMS is unknown.
Drugs stolen from healthcare settings almost always go to support the addiction of a healthcare worker and only rarely are sold (3). EMS personnel who divert drugs away from patients for personal use place their patients, their employers, and their coworkers at risk.
All EMS agencies must have a comprehensive system of inventory control including a thorough process for detecting and investigating drug diversion.
References
1. Employee Responsibility to Report Drug Diversion, 21 C. F. R. § 1301.91 (1975).
2. Evans, B. (2010, July 1). Keep the kids out of the cookie jar. Retrieved from http://firechief.com/biometrics/keep-kids-out-cookie-jar
3. Berge, K. H., Dillon, K. R., Sikkink, K. M., Taylor, T. K., & Lanier, W. L. (2012). Diversion of drugs within health care facilities, a multiple-victim crime: Patterns of diversion, scope, consequences, detection, and prevention. Mayo Clinic Proceedings, 87(7), 674-682. Doi:10.1016/j.mayocp.2012.03.013
