Doug Hooten, CEO of MedStar Mobile Healthcare in Fort Worth, Texas, and Matt Zavadsky, the Chief Strategic Integration Officer at MedStar gave a compelling presentation on drug diversion at the annual meeting of the American Ambulance Association (AAA) on Saturday, Sept. 8, 2018, at the MGM Grand Hotel Conference Center in Las Vegas.
They opened with a sobering point for administrators: if you don’t have a drug diversion/misuse issue in your agency, it’s only because you’re not looking for it.
Ensuring a safe environment for your employees (and your patients) should be the primary goal of any ambulance agency, and Hooten and Zavadsky stressed that uncovering potential drug diversions takes serious focus, effort and investigatory skills. MedStar has developed a very robust process for identifying potential incidents of drug diversions and effectively working through the myriad of issues they create.
And, if you do find an employee potentially committing diversion, what is the most appropriate way to deal with it, for the employee and the profession.
Processes & Recordkeeping Are Critical
Hooten said that you have to look for patterns of how employees use medications, stray from protocols (e.g., give pain meds when it’s not necessarily called for) and even monitor employee attendance, particularly if the employee has a high waste history.
It was noted that paramedics can be pretty creative in how they skim medications. They might give saline to the patient and then transfer the “wasted” medication into the saline container.
Agencies should know the daily usage rates/averages for drugs with a high or moderate potential for abuse, like fentanyl, ketamine and midazolam.
Initially, Medstar created a SharePoint list for documenting medication transactions. After further refinement, they now use a commercially available product, Operative IQ, to track their medication transactions and compliance.
Zavadksy underscored the importance of training staff to properly handle narcotics and document/reconcile their use. MedStar requires employees to reconcile their narcotics. Although not a federal mandate, they’ve found it to simply be a good practice.
At Medstar, each paramedic is responsible for checking the narcotics at the beginning of their shift. They check that the “cap” is intact, the vial is full and at the correct level as all other similar vials, the label has not been compromised and that the vial has been labeled with a unique control number. Field personnel can meet crews to restock their narcotics as necessary.
All of the MedStar administration processes are harmonized with the system’s requirements. A full system audit occurs weekly in conjunction with the office of the medical director with the system flagging anything that’s three times the standard usage as potential abuse.
In addition to requiring drug tests after suspicious cases or after an intersection accident, MedStar uses random drug testing for all employees, including top managers.They use urine analysis as well as hair follicle testing. Hooten pointed out that for drug testing to be effective, you need to determine if an employee is on a “high-risk medication” before incidents happen.
Although MedStar has a zero-tolerance policy for drug diversion, they encourage employees to tell them, and seek help, if they have a problem with drug or alcohol abuse. This self-reporting philosophy shows compassion and that they want to help their employees, but they want trust to be a two-way street.
For more information on drug diversion and Medstar Mobile Healthcare’s program, read the article Best Practices on Controlled Substance Monitoring by William Gleason, EMT-P & Neal Richmond, MD.