As any hospital pharmacy can tell you, drug diversion is one of the biggest issues it faces on a daily basis. It’s why they’re required to comply with a host of federal, state and local regulations that govern inventory accountability.
Controlled substances should be kept in a separate safe or locked refrigerator that only a licensed pharmacist can access.
Certain areas of the pharmacy must maintain physical barriers from the general public. Height markers should be placed at exits to help identify suspects and video cameras should be deployed at strategic locations to enable the hospital to document the movement, dispensing and disposal of controlled substances.
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While no solution is 100% foolproof against opportunistic pilfering or a coordinated heist, the International Association of Healthcare Safety and Security and accrediting bodies such as the Joint Commission and the American Society of Hospital Pharmacists have published guidelines that can help hospital pharmacies decide what measures they should take to most effectively secure their pharmaceuticals.
These guidelines provide a framework for establishing a physical security management program that includes protection practices, policies, procedures and protocols for handling the flow of narcotics and other pharmaceutical supplies throughout the hospital.
But no matter how good a program might look on paper, the only way for it to succeed is if the hospital instills a culture of strictly adhering to security measures — from the top executives and administrators to licensed practitioners, support services and even the custodial staff.
Managing Credentials Poses Challenges
While most hospitals do well when it comes to granting privileges to sensitive areas, where they often fail is in the timely withdrawal of authorization when staff has been reassigned to other areas or is no longer employed by the institution. That’s why it’s important for pharmacy directors to work in concert with their security director counterparts to tightly manage and continually update employee credentials (access codes, card keys, biometric scans, etc.). This ensures that only currently authorized personnel can gain access to sensitive areas such as pharmacy stockrooms, medication storage closets and Pyxis medication carts.
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Integrating high-resolution network video cameras with access control systems adds another vital layer of security because it allows security personnel to verify that the individual using a card key or punching in a code is actually the person authorized to use it.
Another security measure gaining acceptance is the network video door station, especially those augmented with two-way audio capabilities. Staff can monitor these high-definition systems from their workstations to visually and verbally screen anyone approaching the pharmacy before deciding whether to unlock the door and permit them access.
Another important feature of these door systems is that the visual/audio data they generate can be recorded and stored for future reference in case of an incident.
Be Sure to Track Your Shipments to Prevent Drug Diversion
Pharmacy directors are also responsible for providing a safe route for pharmaceutical deliveries from the receiving dock to the secure pharmacy. From the moment a delivery comes off the truck, it must be logged in and accounted.
Adding video cameras to the process provides visual verification of the shipment: where it arrived, when it arrived and its actual content.
This electronic record not only helps to keep delivery drivers and employees honest, but also provides agencies like the Drug Enforcement Agency (DEA) with concrete evidence in case of an event rather than relying solely on eyewitness testimony.
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They can see what was taken and what kind of a security risk the incident posed to people within the hospital. In the aftermath, the video can provide a teaching tool as to how the hospital can improve its security procedures and protocols.
Video Documents Drug Dispensing and Disposal
Maintaining written logs is common practice in a hospital pharmacy, but the procedure relies heavily on the integrity of those making the entries. With high-definition video oversight, an individual’s moral compass is taken out of the equation.
Many hospital pharmacies are now visually documenting all drug dispensing to verify who is picking up specific medications and to which patients they are being administered. Equally important, the video documents the return and disposal of any unused product. This not only limits the opportunity for diversion but ensures that correct protocols are being followed for the proper disposal of controlled and dangerous substances.
While heightened security in the pharmacy is certainly critical, it’s important for hospitals not to overlook security in satellite pharmacies on the floors – whether they are drug rooms or Pyxis carts. Adding video oversight in these areas provides an extra layer of protection against misuse and pilfering.
From my own experience, I’ve seen hospitals where drug rooms are secured by punch button locks where employees have written the code on the doorjamb, which became an open pass for anyone to enter.
Nowadays, a far better practice is to secure doors and Pyxis carts with access control systems that require authorized personnel to use credentialed fobs, key cards or biometric scans. Strategically placed video cameras can record any activity, creating a visual record of who entered the room or opened a Pyxis drawer and what they removed. This provides indisputable proof of culpability should any inventory go missing.
Medication Security Impacts Patient Safety
Medication security is closely linked to patient safety and the quality of care. By instituting tight security measures for all pharmaceuticals — through physical security measures such as tamper-evident locks, continuously updated credentials for access control and video surveillance oversight — hospitals can minimize drug tampering and drug diversion. This instills confidence in the physicians prescribing the medication, the staff administering it, and the patients who receive it.
Paul Baratta is the healthcare industry business development manager for Axis Communications. He has more than 26 years of law enforcement and security management experience. This article was originally published in 2017, but the recommendations still apply.
NOTE: The views expressed by guest bloggers and contributors are those of the authors and do not necessarily represent the views of, and should not be attributed to, Campus Safety.
