Technology struggles to beat thieves

This image courtesy of Omnicell shows a nurse accessing an automated medication dispensary using her fingerprint to gain access to the system. A touch screen shows the nurse the medications that have been ordered for each patient. The cabinet lights up to show where the medications are located in the cabinet, and the system keeps track of the inventory levels so they can be restocked before they run too low.(Photo: Omnicell) Narcotics are as old as the Sumerians who cultivated opium from poppies in 3400 BC, and so is the use of narcotics by healers. Today, nurses have the most contact with drugs in the health care workplace — and the most opportunities to steal them, an infraction the industry calls "diversion." "Nurses are the No. 1 care provider with regular access to controlled substances," said Kimberly New, a medication security consultant and executive board member of the National Association of Drug Diversion Investigators. "We detect a lot more nurses than pharmacy staff diverting medications in inpatient settings." Storing, charting, counting and administering drugs are part of almost every nurse's duties. Patients need medication, and they need it often. Care you receive in a modern professional medical facility usually includes them. But even though the core duties of a nurse are similar from facility to facility, no two workplaces seem to handle drug tracking, reporting and security the same way. DIFFERENT SECURITY SYSTEMS If the nurse works somewhere other than a hospital, such as a long-term care facility, chances are the medications are stored in an old-style cabinet that uses metal keys, two of them, to unlock the doors. The cabinet usually is in a room that itself is locked, and has a locked refrigerator to hold perishable drugs. It's the easiest setup to game. and also the most time-consuming and mistake-prone, because of the way the medications are tracked. The nurse has to manually record a host of details each time a drug is removed from the cabinet — date, time, name of patient and much more. At the end of the shift, the incoming nurse hand-counts the narcotics in the presence of the outgoing nurse, who verifies the count, almost like when convenience store clerks change shifts and count register drawers. As Xerox is to copiers, so Pyxis is to medicine carts, another common way medications are dispensed. While Pyxis offers newer models with updates, their older carts — which many facilities still use — have drawers for each patient's medications and don't feature higher-end technology. With a manual entry each time a drug is dispensed and a manual count at the end of the nurse's shift, they are also easy to trick. AUTOMATION BRINGS POWER The state-of-the-art technology used by roughly 80 percent of acute-care hospitals involves an automated dispensing machine, similar to a vending machine, that requires a barcode or a username and password to gain access to the medication drawers. Hospitals can set up the system so nurses are able to access only the medication for their assigned patients. From a patient safety perspective, the real breakthrough comes with the software. In Fishersville, Augusta Health upgraded this year to an automated dispensing solution from Omnicell that creates a transaction record each time medication is dispensed. Originally developed to save hospitals time by eliminating hand counts, the electronic records have become a valuable security tool, allowing a nursing or pharmacy director to isolate suspicious dispensing patterns to a particular caregiver. "The technology allows us to run reports at the end of each shift to reconcile all the medications," Augusta Health spokeswoman Lisa Schwenk said. If there's a discrepancy, the software can analyze the transaction data and generate red flags — for example, a nurse with a high number of morphine transactions compared with others on the unit, signals possible theft or error. USING THE TOOLS New previously oversaw a diversion program at University of Tennessee Medical Center that used Pandora analytics software. At one of the hospitals where New worked, she saw one nurse climb to the top of the chart. "She was a new employee and had just been through orientation," New recalled. "She immediately started diverting Percocet by taking doses that were never documented." Using her analytic tools, New typically found nurses stealing medicine once or twice a month. "Diversion is universal, so if you don't catch it in a year, it's a reason to look at your process," she said. In addition to causing pain, worsening health and even death, drug "diversion" costs consumers money every time they're charged for medications they didn't receive. Hospitals can, if they choose, use their transaction reports to correct the patient's bill if diversion occurs. All the required data is already there — patient name, data, time, medication, dose — and can be exported to the billing department to reverse the charge. HIGHEST RISK DRUGS The Drug Enforcement Administration "schedules" drugs partly according to their potential for abuse and addiction. Most health care facilities take security measures for drugs in Schedules II through V. Schedule I drugs aren't used in a medical setting in Virginia. •Schedule I: Heroin, marijuana and other non-prescribed opiates •Schedule II: Prescription opiates and amphetamines such as morphine and fentanyl, as well as methadone, Ritalin, oxycodone and high doses of codeine •Schedule III: Steroids and barbiturates such as buprenorphine and paregoric tend to lead to psychological dependence when abused. Physical dependency is less intense. •Schedule IV: Some barbiturates and partial opioids are rated less potentially addicting than Schedule III drugs, including Xanax, Librium, and Valium and Ambien •Schedule V: The least risky substances such as certain cough suppressants that include opiates in low doses to treat common ailments Read or Share this story: http://www.newsleader.com/story/news/special-reports/2014/12/05/addicted-nurses-technology-struggles-beat-thieves/19907913/