Doctors, nurses and other hospital staffers can fall prey to painkiller addiction, just like anyone else. But unlike the general public, the potential for increased access to opioids at work raises the stakes for health care workers and their employers.
Diversion of drugs among staff is an issue that’s grown in importance. David Harlow, chief pharmacy officer of Martin Health System in Stuart, Fla., says that at any given time, Martin Health officials are monitoring an estimated 10 or so individuals for possible signs of diversion.
He believes the issue needs to be on the radar of hospital C-suites, and building awareness is a key first step. “I think, for a lot of organizations, this is an afterthought. It’s something they see as a drudgery that is touted by pharmacy, but really it’s an organizational imperative,” says Harlow, who is also assistant vice president of professional services at Martin. “Once you start looking at how the government views this issue, it has the same gravity as the Joint Commission, as CMS, as anything else. This is a big, big deal.”
Kim New, a diversion expert who formerly worked with the University of Tennessee Medical Center, says that human resource departments play an important role in what should be a formal, robust process that hospitals have in place for responding to such situations.
New believes hospitals must have surveillance measures in place for all narcotics stored at a facility, and conduct ongoing audits to check supply levels. That includes taking account of diversion policies and procedures to make sure that they match up with industry best practices. Hospitals need to make sure to report any diversions to the state medical board, in order to help prevent possible future diversions.
Hospitals should have in place a formal process or a dedicated group that is going to make sure that any diversion is responded to appropriately, and also is guiding the program forward,” New says.
Sherry Umhoefer — a former pharmacist with the Mayo Clinic and compliance and regulatory expert with Comprehensive Pharmacy Services, Memphis, Tenn. — says the most critical step hospitals can take is educating staff and reporting occurrences. Failing to report the incident to law enforcement or the relevant boards, be it pharmacy, nursing or another — can be enabling to diverters and keep the problem alive, Umhoefer also says.
Diversion can also pose a risk to patient safety, if clinical staff members are tampering with meds to hide the fact that they are diverting opioids.
Above all else, hospitals need to remember that addicted docs and other staffers are sick people, just like patients in the same situation, and they need compassion and care, says Bradley Hall, M.D., president of the Federation of State Physician Health Programs. The worst thing hospitals can do is to let stigma affect their judgment, or to simply pretend that this problem doesn’t exist, he says.
“These sick physicians are really members of the human race with different degrees after their names,” says Hall, who is also medical director of the West Virginia Medical Professionals Health Program.