Not talking about the problem doesn't make it go away, but being prepared will help HR teams deal with it when the issue comes up—and sooner or later, it will.
No one wants to believe one of their employees is diverting drugs meant for sick patients. That makes frank discussion of drug diversion between management and employees uncomfortable and difficult.
But odds are good that someone in your hospital is taking drugs intended for patients. An estimated 100,000 healthcare workers in the United States are addicts and as many as 20% of nurses are estimated to have substance abuse problems.
Donna Patty, RN
The most well-known case of drug diversion may be the case of a contract radiology specialist caught after a stint at an Exeter, NH, hospital, who for years took advantage of lax screening and reporting policies to gain access to multiple health system's drug supplies. He was eventually apprehended once authorities realized he'd spread Hepatitis C to at least 46 patients nationwide.
Disturbing cases like this are why hospitals need proactive policies are necessary to deal with the problem.
"Drug diversion is something most organizations don't want to talk about, but we realize it's a concern, not just in our organization, but also nationally," says Donna Patty, RN, compliance specialist at University of Tennessee Medical Center. "We just chose to be very proactive in our approach instead of reactive."
By acknowledging that drug diversion is a real risk, human resources leaders can implement policies to protect patients, help addicted staff, and ensure that the organization is in compliance with regulations.
Stick to the Process
UTMC has a defined process in place for dealing with drug diversion, says Patty.
"Human resources informs compliance of any issue related to drug diversion. Compliance investigates, and then HR and the [suspected employee's] manager will determine what to do based on the results of that investigation.
If, during a reasonable suspicion drug test… the employee tests positive [for drugs], the employee is discharged immediately."
The employee might also be discharged if he tests negative but evidence is found during the investigation that he has been involved in drug diversion.
The process is in writing and has been vetted by all pertinent departments at UTMC. Employees and their managers are aware of it, and everyone in the hospital understands that drug diversion is unacceptable and will result in termination.
Not all organizations require that employees be terminated if caught diverting drugs. Some require that staff be moved to a non-drug dispensing role after attending treatment or have other policies. What's important is to have a policy before the issue comes up, and to ensure that all employees and department leaders are aware of it.
Amy Flatt, associate director of pharmacy at UTMC, agrees that being prepared is the key to avoiding drug diversion and handling it successfully when it does arise. "It's very important to determine what your policies are prior to an incident happening. You need to have a plan on what to do…. You must be ready as an institution."
Trying to figure out what to do "on-the-fly" usually backfires, says Julie Rice, RN, manager of health, wellness, and peer assistance programs at the American Association of Nurse Anesthetists. "[Organizational response] needs to be carefully organized and prepared."
"Start collecting all the facts," says Linda Stone, chair of the peer assistance advisors committee at AANA and associate director of didactic and clinical education at the Raleigh School of Nurse Anesthesia / UNC, Greensboro.
Now is the time to find witnesses, look at surveillance tapes, review electronic data, and start building your case. If the evidence warrants it, order a drug screen for the suspected employee. Once you have enough information to confirm your suspicions or a positive drug screen, it's time to move forward to the next phase of the process.
Confront the Employee
This confrontation shouldn't be chit-chat where the employee promises to get help or simply denies that he has a problem. Nor should it be a standard termination of employment. If possible, the confrontation should be an intervention, say Stone and Rice.
"The intervention needs to be carefully organized and prepared. It should not be [spontaneous]," Rice says. Whenever possible, involving the employee's family can be helpful.
Organization with employee assistance programs, should involve the EAP, says Stone.
Rice and Stone suggest designating a facility where the employee will go after the confrontation. This serves multiple purposes. First, it ensures them that help is available; second, it prevents them from immediately seeking employment before this incident is reported; and perhaps most important, it may prevent them from doing something regrettable.
"The chances of suicide are pretty high due to the risk to licensing—and to [the healthcare worker's] reputation," says Rice. The employee should not be allowed to leave the confrontation alone for this reason.
Rules for confronting employees vary according to state, so HR executives should check with the legal and compliance departments to ensure permissibility prior to proceeding.
Julie Rice, RN
The CNO or CMO should report the incident to the state boards and to law enforcement. This step is frequently avoided due to concern about negative attention, but avoidance puts communities at risk, says Rice. "if you know of diverting, you have an obligation to report it."
An Ounce of Prevention
Prevention policies that can minimize chances of drug diversion.
The first step is to educate healthcare workers about the dangers of narcotics and the signs of a coworker that might be diverting.
UTMC has sent members of its compliance team to talk to nursing, pharmacy, and medical students about the disastrous effects that recreational abuse of these drugs can have on life, health, and patient safety. Rice and Stone say their organization teaches awareness of drug addiction among clinicians and the signs of drug use at work.
Interdepartmental scrutiny also helps keep organizations on their toes. "Make sure the entire hospital works as a team…. everyone here could be affected by diversion in some way. Here, compliance looks at pharmacy. Pharmacy looks at anesthesia. We all monitor each other," says Flatt.
Another tip: promote a culture of safety in your hospital. "It influences relationships between coworkers. They realize situations can be handled fairly. Employees are more likely to report drug diversion if they think there will be safe handling," says Rice.
The key to tackling this tough topic is to start the conversation among healthcare leaders. Not talking about the problem doesn't make it go away, but being prepared will help HR teams deal with it when the issue comes up—and sooner or later, it will.
Lena J. Weiner is an associate editor at HealthLeaders Media.