Community Health Systems Webinar The Role of the Pharmacist in Diversion Prevention, Detection and Response August 17, 2016 Kimberly S. New, JD, BSN, RN Consultant, Institutional Diversion Education and DEA Regulatory Compliance Diversion Specialists Knoxville, Tennessee Terrie Van Buren, RN, BSN, MBA, CPPS Senior Director Patient Safety Officer Community Health Systems Jerry Reed, MS, RPh, FASCP, FASHP Senior Director, Pharmacy Services Community Health Systems Question & Answer Session The following questions were not addressed during the live Q&A session. Q: Where can we purchase a refractometer that can detect fentanyl? A: Kimberly New: I don’t endorse products, but I am aware that Rudolph Research Analytical and Dynalabs both have products that can analyze for fentanyl on a routine basis. Q: Why isn't hair follicle testing used to screen for prior drug use instead of urine? A: Kimberly New: Hair follicle testing is widely used in non‐healthcare settings. Most healthcare clients I work with state the expense and invasiveness are the two reasons they don’t do it. It is more expensive that urine drug screening and requires around 100 hairs as a sample. Hair follicle testing does provide excellent data regarding prior drug use, so it would be great if it were more commonly done in this setting. Q: What is your opinion on missing documentation and/or orders and late documentation or late orders being written? A: Kimberly New: If I understand the question, from a diversion perspective, late documentation is problematic. Routinely prompting providers to input late documentation and orders can hide diversion. The best practice across the US is that medical record entries are required to be made in the regular course of business at or near the time of the matter being recorded. AHIMA policy is that patient record entries should be documented at the time the treatment they describe is rendered. If late entries are made, they should be labeled as such. All late entries should be recorded and monitored so that patterns for particular staff can be detected and addressed. Q: I am shocked that gabapentin isn't considered a control substance yet federally. Are there any plans that it will be considered a control substance on the horizon? Will CHS start to treat it as a control anytime soon? A: Jerry Reed: It is surprising that gabapentin is not regulated as is pregabalin (Lyrica) which is a closely‐related drug acting similarly to benzodiazepines in that it affects the neurotransmission of GABA. Anecdotal information on gabapentin’s analgesic effect, reported dependence claims, mood altering abilities, and reported “intoxicating” effects at high doses support adding more controls. Even if this drug is not controlled by Corporate policy, your facility can make the policy more stringent by establishing your own controls. If diversions of this drug are reported to Corporate, consideration may be given to controlling gabapentin as we do with other drugs listed in CHSPSC Policy RX15‐11, Drugs Requiring Inventory Accountability in Acute Care Facilities. 1 Q: Can we get Cerner to create a task that fires q shift when a patient is on a narcotic patch to allow nursing to document that the patch was in fact present and intact? We used to do this at our facility with good results. We were told it had to be handled as part of the nurse assessment/shift report. A: Jerry Reed: This is a good suggestion. I will submit a request to the Corporate Cerner implementation group to consider this enhancement. ProCE, Inc. 848 W. Bartlett Road Bartlett, IL 60103 630.540.2848 www.ProCE.com 2