You could call it a nightmare scenario, but it’s all too real.

In July, the New Hampshire Department of Health and Human Services was scrambling to organize hepatitis C testing for more than 3,000 Exeter Hospital patients and former patients. More than 30 patients had already been diagnosed after receiving treatment from the hospital’s cardiac catheterization laboratory.

Tragically, authorities believe that the patients were infected via the actions of someone who was supposed to protect them: an Exeter Hospital employee.

Technician David Kwiatkowski is accused of stealing drugs from the hospital and contaminating syringes that were later used on patients.

This scenario is all too common, according to Alan Robinson, director of Protection and Security Services for Atlantic Health System in New Jersey.

“Anywhere between 6% and 20% of all RNs have a drug addiction problem,” Robinson claims. “We don’t see a lot of cases where people are stealing [drugs from our hospitals] to sell them.”

Dispensing System Helps Keep Track
At each of its four hospitals, Atlantic Health System uses a medication dispensing system from Pyxis to keep track of what — and how much — medication is distributed on each floor.

“It’s kind of like an ATM machine for narcotics,” Robinson says. “The nurse on the patient care unit — or other healthcare professional with access to medication based on the doctor’s orders — has to put in personal identification so that the machine knows it’s the caregiver.  Then whatever she withdraws, [the machine] keeps a record of it.” The system also uses biometrics.

Chuck Moore, security director at Northwest Hospital in Randalls Town, Md., says his facility uses the MedCarousal dispensing system from McKesson to track the distribution of medication.

“There is a perpetual inventory for each item,” he explains. “As doses are dispensed, the inventory is decremented.”

Review Reports Regularly
As medical staff get medication from the dispensing system, Robinson says, that data is compiled and placed into a Pandora Analytics report, a service of Omnicell.

The Pandora report provides a historical and empirical view of the medication being used in each wing of the hospital. For example, if nurses typically withdraw Demerol four times a day in the orthopedic area of the hospital, the report will display that average, as well as what took place each day.

“If that number would get to 30, or 35 or 40, the Pandora system automatically issues a report that says, the norm for that floor is 15 and this is what they call an outlier — in other words, way above what the norm is for that floor,” Robinson says.

Nursing Staff Can Catch Thieves
Both the nurse managers and the hospital security department receive these reports, Robinson explains. However, the nurse managers have primary responsibility when it comes to recognizing possible drug diversions.

It’s easier to catch on to drug diversion “if there’s a good conversation between the nurse manager and the pharmacy as opposed to security looking for trends,” Robinson says. While security personnel may look for patterns to identify theft, “our nurse manager is looking at these reports and saying ‘wait a minute, this nurse’s behavior has been off or her attendance is off’ or whatever the case may be.”

If a nurse manager identifies a possible theft,  he or she should contact the security department to perform a follow-up investigation.

“As soon as an issue involving drug diversion is suspected, a trained investigator needs to be brought in,” Moore says. “Many drug diversion cases are lengthy, which includes following paper trails, CCTV evidence, access control transaction reports, etc. A delay in notifying an investigator could cause evidence to go stale or even disappear.”

Indicators Can Be Misleading
Any withdrawals from a hospital’s medication dispensing system should be verified by doctors’ orders. However, if they aren’t, there are some other plausible explanations.

Atlantic Health System hospital staff perform drug inventory each time they withdraw medication from the Pyxis machine. The healthcare worker must verify the count that is displayed and avaliable in the system as they are making a withdrawl, so a discrepancy in the amount of inventory will be caught quickly, Robinson says. In some cases, this only indicates an error on the part of the personnel who restocked the Pyxis machine.

Robinson says healthcare safety professionals should also be aware that traditional indicators of drug abuse might not apply to hospital employees.

In the past, “if someone had a drug problem, you started looking for their attendance to slip,” he says. “We’re finding in the last two years that sometimes their attendance is absolutely perfect because their access to medications is at the hospital.”

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