Your Resource for HQIC News and Learning Opportunities | August 2023 | |
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Drug diversion—the deflection of prescription drugs from medical sources into the illegal market—by healthcare workers threatens patient safety and may occur anywhere in the supply chain.1 Drug-diversion risk-reduction strategies include preventing, identifying, reporting, and responding to any suspected diversion.2
Preventing
Drug-diversion prevention strategies may involve establishing a prevention program to include an interdisciplinary committee, a dedicated diversion officer, unannounced diversion-risk rounds in the pharmacy and other departments, and a “trust-but-verify” approach to controlled substance handling.
Though education is considered a low-level strategy, it is recommended to inform staff about the steps that have been implemented to prevent drug diversion, signs of drug diversion, and how to report and respond to drug diversion. Also include patient education on how to safely secure and dispose of medication.2
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Identifying
Drug-diversion identification improves patient safety risk. Consider these strategies:
- Install cameras with secure recordings in risky areas.
- Monitor prescribing habits among similar provider groups.
- Audit medication administration records to determine how often patients were prescribed opioids and did not receive them.
- Monitor controlled-substance access data.
- Monitor for excessive restocking of controlled substances.
- Audit controlled-substance administration variances across shifts, with attention to increased dose administration not linked to patient condition or frequent documentation of patient refusal.
- Reconcile the amount of drug obtained versus amount recorded and any witnessed drug waste occurring in high-risk areas.
- Use a refractometer or other technology to confirm whether random waste samples contain the expected medication.
- Conduct personal observations.2
Reporting and Responding
Lastly, reporting and responding improve patient-safety risk. Consider these strategies:
- Report and manage all discrepancies immediately upon discovery and per policy.
- Establish a reporting platform to maintain confidentiality of staff reporting.
- Establish a standard process for drug-diversion investigations.
- Avoid drug addiction stigmatizing language.
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Ensure compliance with relevant state and federal agencies.2
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Opioid Measure Progress
Data show that opioid measures have improved since the baseline period of 2019 (lower rates are better).
Visit the HSAG HQIC Quality Improvement Innovation Portal (QIIP) to view your Opioid Measure progress by selecting the Measure Category of Adverse Drug Events (ADEs) and the Measure of ADE Opioid, Benzo Co-Prescribing, and ≥ 90 morphine milligram equivalents (≥ 90 MME).
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*Rates are per 1,000 admissions. Source: Medicare Fee-for-Service (FFS) claims data. For additional details on measure specifications, please reference the HSAG HQIC Compendium of Measures. The baseline time period is 01/01/2019–12/31/2019 and the current time period is 04/01/2022–03/31/2023. | |
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ADE—Opioids Roadmap to Success
Implementing evidence-based guidelines and protocols is an integral part of opioid management to minimize the risk of ADEs. This roadmap offers step-by-step planning strategies for hospitals setting up opioid stewardship programs.
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Opioid Stewardship Program Assessment for Emergency Departments
This assessment assists emergency departments in evaluating their opioid stewardship program, including the areas of commitment, action, tracking and reporting, and education and expertise.
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National Prescription Drug Take Back Day October 28
Sponsored by the U.S. Department of Justice and the Drug Enforcement Administration, the bi-annual National Prescription Drug Take Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the public about the potential for abuse of medications. Find information on how to participate on their website.
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Contributors to Diversion of Controlled Drugs in Hospitals
This Journal of Hospital Medicine article includes the contributors to diversion at each stage of the medication use process. There is also a helpful literature summary. Scroll down to Table 2 to see a list of contributors to drug diversion at each stage of the medication-use process, including: procurement, storage, prescribing, preparation, dispensing, administration, and more.
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Institute for Safe Medication Practices (ISMP) Drug Diversion
Controlled substance drug diversion by healthcare workers is a threat to patient safety. This part-2 article covers how to prevent, identify, report, and respond to drug diversion.
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ISMP Hierarchy of Effectiveness of Risk-Reduction Strategies
This article, “Education Is 'Predictably Disappointing' and Should Never be Relied Upon Alone to Improve Safety,” outlines why education alone is a weak, low-value improvement intervention. Scroll down to Figure 1 to find the full hierarchy list.
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Readmissions are associated with poor patient outcomes and can be costly for hospitals and patients. In addition, the 30-day readmission rate is an important quality measure for hospitals.3
Many readmissions are preventable and can often be attributed to avoidable factors, such as issues in post-discharge communication, planning, and follow-up. Identifying these gaps in care that cause readmissions is an important step in improving care transition practices and deciding which areas need focused process improvement projects.4 The HSAG HQIC 30-Day Readmissions Audit Workbook guides record review, helping facilities identify common contributors to readmission and autogenerate graphs to support visualization of your facility's performance.
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Care Coordination
Quickinar Series
| Continue your care coordination journey for managing avoidable hospital readmissions by registering for these short, 30-minute webinars (quickinars)—offered monthly, through May 2024. Find details and recordings for past presentations on the webpage. | | |
1st Tuesdays. Next: September 5, 2023 | 2–2:30 p.m. ET (11 a.m. PT) | |
Emergency Preparedness Plan (EPP) Webinars
| These short, 45-minute webinars discuss key areas for a successful EPP, followed by a Q&A session. Presentations cover up-to-date information/resources and areas of focus included in a comprehensive EPP. | | |
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Hosted by HSAG, in partnership with the California Association of Health Facilities (CAHF), Arizona Coalition for Healthcare Emergency Response (AzCHER), California Hospital Association (CHA), California Long-Term Care Ombudsman, the California Department of Public Health (CDPH), local health departments, the California Association of Long Term Care Medicine (CALTCM), and others.
3rd Wednesdays. Next: August 16, 2023 | 6–6:45 p.m. ET (3 p.m. PT)
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Online Recordings and Podcasts
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Find on-demand quickinar recordings, slides, and podcasts for past HQIC learning series. | |
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Health Equity Quickinar Series
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This series addresses the many facets and criteria for hospitals to meet the new CMS Hospital Commitment to Health Equity Structural Measure and Social Drivers Screening Measures.
CMS = Centers for Medicare & Medicaid Services
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Patient and Family Engagement (PFE) Quickinar Series
| This series addresses the CMS 5 Metrics for PFE and provides facilities a framework to engage patients and families in their care. | | |
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Quality and Safety Quickinar Series
| Find resources to assist your quality improvement journey, from planning and preparation to sustaining your organization's gains. | | |
This material was prepared by Health Services Advisory Group (HSAG), a Hospital Quality Improvement Contractor (HQIC) under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication No XS-HQIC-XT-08012023-01 | | | | |
