Confirmed Medication Diversion in Hospice Care: Qualitative Findings From a National Sample of Agencies

Ware, Orrin D.; Cagle, John G.; McPherson, Mary Lynn; Sacco, Paul; Frey, Jodi Jacobson; Guralnik, Jack M.

doi:10.1016/j.jpainsymman.2020.09.013

Cited by 7 publications

(10 citation statements)

References 19 publications

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“…Vigilant medication monitoring (e.g., pill counts) can help providers identify when opioid medications are unaccounted for. 9,25 Findings from this project, but reported elsewhere, 9 estimate that 84% of hospices conduct pill counts, 78% screen for patients for risk of substance misuse or addiction, and 44% screen family members for such risks. Qualitative descriptions from hospice staff about the most recent case of confirmed diversion suggests that hospices are sensitive to diversion concerns, have taken measures to mitigate risks, and respond nimbly when diversion is identified, all while simultaneously working to ensure compassionate, high quality end-oflife care.…”

Section: Discussionmentioning

confidence: 77%

“…Missing medications are a potential indication of medication misuse. 25 The majority of hospices have policies and documentation processes for dealing with missing opioid medications. Our past work suggests that similar policies (i.e., those dealing with suspected drug misuse or diversion) are positively associated with confirmed cases of diversion.…”

Section: Discussionmentioning

confidence: 99%

“…Qualitative descriptions from hospice staff about the most recent case of confirmed diversion suggests that hospices are sensitive to diversion concerns, have taken measures to mitigate risks, and respond nimbly when diversion is identified, all while simultaneously working to ensure compassionate, high quality end-oflife care. 25 A recent Delphi-consensus project provides recommendations to hospice providers on strategies for dealing with missing medications and mitigating risk for medication misuse and diversion. 26 Nearly a quarter of hospices reported they had discharged a patient from service due to concerns about medication diversion in the past 12 months.…”

Section: Discussionmentioning

confidence: 99%

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A National Survey of Challenges Faced by Hospices During the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death

Cagle

McPherson

Frey

et al. 2021

Journal of Pain and Symptom Management

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Context. No national data exist on hospice medication shortages, the frequency that opioid medications go missing, and drug disposal practices.Objectives. To provide national estimates for hospices on: drug shortages; frequency of missing medications; and opioids left in the home post-death.Methods. A national survey of 600 randomly selected hospices stratified by state and profit status (data collection 2018). Sample weights were applied to adjust for non-response. Respondents were hospice representatives knowledgeable about agency policies and practices. Participants reported their knowledge and perceptions about medication shortages, frequency that opioid medications go missing, and the proportion of hospice deaths in which opioids are left in the home. Findings were stratified by agency size.Results. 371 hospices completed surveys (response rate = 62%), half (50%) of which were mid-sized (26-100 patients), and not-for-profit. Respondents had 7.5 years (SD = 7.7) of agency experience. 42% of hospices − and 61% of large hospices − reported medication shortages. Among the full sample, 28% of agencies indicated shortages of morphine; 20% reported shortages of hydromorphone. Nearly half (43%) of hospice representatives reported that missing opioid medications occurred within the last 90 days. 52% of representatives reported employees are not allowed to dispose of medications after a home death; and, among home deaths, unused opioids were left in the home 32% of the time. This suggests opioid medications are frequently left in U.S. households after a hospice home death.Conclusion. Hospices face numerous challenges during the national opioid crisis. Interventions are needed to ensure access to needed treatments, mitigation of diversion, and safe medication disposal.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A National Survey of Challenges Faced by Hospices During the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death

Cagle

McPherson

Frey

et al. 2021

Journal of Pain and Symptom Management

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“…The narratives were coded by a doctoral-level researcher “ODW” with experience using the template analysis and open-ended thematic methodology 33 , 34 and providing clinical services in Baltimore, MD as a licensed social worker with persons who have a substance use disorder, a master’s level researcher “BL,” and a bachelor’s level researcher “DH.” The study PI “MMS” oversaw the coding and would provide a tie-breaking vote in the event of 3 different codes. The master’s and bachelor’s level researchers were trained in the template analysis methodology by the doctoral-level researcher.…”

Section: Methodsmentioning

confidence: 99%

Prior Periods of Abstinence Among Adults With an Alcohol Use Disorder: A Qualitative Template Analysis

et al. 2023

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Abstaining from substance use is a goal of many people with alcohol use disorder (AUD). Understanding patient perspectives of a period of abstinence may assist persons with AUD in achieving this goal. We accessed the electronic health records of adults with AUD entering an emergency department in Baltimore, Maryland, who received a brief peer support intervention for substance use. Data contained open-ended text entered by staff after a patient indicated ever having a sustained period of substance abstinence. Using qualitative template analysis methodology, we identified codes and themes from these open-ended responses from N = 153 adults with AUD. The sample was primarily male (n = 109, 71.2%) and White (n = 98, 64.1%) with an average age of 43.8 years (SD = 11.2). Themes identified included the abstinence length, abstinence reason, relapse, triggers, time of relapse, and treatment. The most common code for abstinence length was “between 1 and 5 years” (n = 55, 35.9%). Other abstinence length codes included “less than 1 year” and “more than 5 years.” Relapse triggers included “family (non-death),” “death of a loved one,” “social,” “economic,” and “treatment-related” reasons. Findings from this study could be used to inform strategies for peer support interventions to assist patients with substance abstinence.

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“…Older adults have long been victims of CS theft by health care workers (Inciardi et al, 2006;Span, 2012) and family members (Roberto et al, 2021) in their homes. These thefts also occur in healthcare settings such as hospitals (Fan et al, 2019), hospice (Ware et al, 2021), pharmacies (Martin et al, 2013), pain clinics (Walker & Webster, 2012), as well as during people's transition from hospitals to nursing homes (Kind et al, 2014;Tjia et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Theft of Controlled Substances in Long-Term Care Homes: An Exploratory Study

2023

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The theft of controlled substances has been studied in the community and healthcare settings including hospitals, pharmacies, hospice, and pain clinics. However, research on these thefts in long-term care homes has yet to be published. This exploratory study makes first steps toward bridging this gap. Using 107 Minnesota Department of Health’s investigation reports substantiated as “drug diversion” between 2013 and 2021 in assisted living residences and nursing homes, we found that 11,328.5 tablets were stolen from 368 residents (97.5% were controlled substances), with over 30 tablets stolen per resident. We also identified the types of medications stolen, duration of theft, extent to which nurses stole the medications or were those initially suspecting thefts, and the role of surveillance cameras in confirming allegations. The findings could raise awareness to this form of elder mistreatment in long-term care homes and call for action to address it.

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Confirmed Medication Diversion in Hospice Care: Qualitative Findings From a National Sample of Agencies

Cited by 7 publications

References 19 publications

A National Survey of Challenges Faced by Hospices During the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death

A National Survey of Challenges Faced by Hospices During the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death

Prior Periods of Abstinence Among Adults With an Alcohol Use Disorder: A Qualitative Template Analysis

Theft of Controlled Substances in Long-Term Care Homes: An Exploratory Study

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