Page 24 - Campus Security & Life Safety, May/June 2021

"To address the problem of drug diversion that could be occurring via the dispensing machines on nursing floors, video surveillance should be installed to monitor them. This security practice is becoming more common today than it was five years ago."
Protecting drugs, medications and sup- plies within a healthcare setting is a vital assignment. When licit and medi- cally necessary drugs are taken and used for illicit purposes, it’s called drug diversion — and it has far-reaching conse- quences. It can be a life-or-death matter, which is why there are guidelines from the American Society of Health-System Pharma- cists (ASHP) for preventing diversion of con- trolled substances. These guidelines include core administrative elements, system-level controls such as monitoring and surveillance, and provider-level controls.
Drug Diversion
When healthcare employees steal prescription medicines or controlled substances, such as opioids or even the COVID-19 vaccine for their own use or to sell — puts patients at risk, according to the Centers for Disease Control and Prevention (CDC). This manifests in sev- eral ways, including substandard care deliv- ered by an impaired healthcare provider; denial of essential pain medication or therapy; and risks of infection if a provider tampers with injectable drugs, the CDC describes.
There can be financial consequences for healthcare providers, as well. In May 2018, the U.S. Attorney’s Office, Southern District of Georgia, announced that Effingham Health System, Springfield, Ga., had agreed to pay the United States $4.1 million to “resolve allega- tions that Effingham Health System failed to provide effective controls and procedures to guard against theft and loss of controlled sub- stances, leading to a significant diversion of opioids, and failing to timely report the sus- pected diversion to the Drug Enforcement Administration (DEA).”
The incident was thought at that time to be the nation’s largest settlement of its kind involving allegations of drug diversion at a hospital. U.S. Attorney Bobby L. Christine said in the announcement, “Hospitals must adopt and maintain effective safeguards as a bulwark against diversion — the risk to the public is simply too great to accept anything
less than what the law demands.”
The Joint Commission, an independent,
not-for-profit group in the United States that administers voluntary accreditation programs for hospitals, stated that “only a fraction of those who are diverting drugs are ever caught, despite clear signals....” This leads to the importance of having a controlled substances diversion prevention program (CSDPP), a guideline that is provided by the ASHP.
“Ultimately, each organization is responsi- ble for developing a CSDPP that complies with applicable federal and state laws and regulations but also one that applies technol- ogy and diligent surveillance to routinely review process compliance and effectiveness, strengthen controls, and seek to proactively prevent diversion,” the guideline states.
The Joint Commission emphasizes that there are three essential components that healthcare organizations must consider when dealing with drug diversion: prevention, early detection and appropriate response. Under the heading of early detection is the topic of having systems in place such as video moni- toring of high-risk areas like pharmacies.
Central Fill Pharmacy
Most hospitals have a state-authorized central fill pharmacy, where controlled substances are amassed and then may be distributed to satel- lite pharmacies throughout the hospital, such as at autonomous dispensing machines called Pyxis MedStations. Hospitals have a process for moving narcotics from the central fill pharmacy to the machines on various hospital floors — for example, the drugs may need to
be escorted by at least two pharmacists and sometimes a security officer.
Every hospital has a mandatory policy that provides for a security management program. In that policy, the hospital must identify its “sensitive areas,” one of which is pharmacies. Once an area is identified, then security must be added, minimally with 24/7 video surveillance and restrictive access con- trol. Often chemotherapy and other medica- tion is prepared in the central fill pharmacy, making it necessary for the hospital to video- record all activities within.
Traditional video can be enhanced with analytics and network audio to make it a proactive security tool. The analytics can “predict” security concerns in real time, while the network audio can extend the reach of the surveillance system to give it not only “eyes,” but “ears.”
There is always a risk of somebody trying to forcibly enter a sensitive area in a hospital, so security cannot be understated. When a visi- tor presses a button on an intercom or net- work door station to request entry, the person on the other side can see and speak to the visitor. Cameras should be on both sides of the door, and there should be a second camera in the hallway leading to the pharmacy door, so the pharmacist can observe that the visitor is alone before granting access.
Dispensing Locations
To address the problem of drug diversion that could be occurring via the dispensing machines on nursing floors, video surveil- lance should be installed to monitor them.
Healthcare Security
24 campuslifesecurity.com | MAY/JUNE 2021