Utilisation optimale des cabinets automatisés décentralisés : le point sur les risques de détournement des substances désignées

Dubois, Sophie; Bernier, Emmy; Rivard, Julie; Yu, Lavina; Atkinson, Suzanne; Bussières, Jean-François

doi:10.4212/cjhp.v70i2.1644

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…8 Examples include using electronic ordering, dispensing, and administering record systems that do not automatically identify discrepancies ( tool/technology factor) 9,10 ; stocking medications in unit dose packages larger than the doses that are typically ordered resulting in the accumulation of drug waste that is prone to diversion ( organization factor) 8,11 ; placing the medication preparation area in a dimly lit low traffic location where tampering can occur hidden from view ( environment factor) 12 ; and having one healthcare provider retrieve and prepare medications that are administered by another provider which obscures the chain of custody ( task factor). 1,12,13 Guidelines and recommendations to mitigate diversion risk have focused on person-based interventions (e.g., remedial training and policy/protocol reinforcement). 1,12 Identification of more effective multifaceted system-based interventions, such as environmental redesigns, technological solutions, and organization-wide commitment to diversion, 3 requires an understanding of the underlying workflow and the environmental, technological, organizational, and other system factors contributing to diversion risk.…”

Section: Introductionmentioning

confidence: 99%

Critical vulnerabilities for diversion of controlled substances in the emergency department: Observations and healthcare failure mode and effect analysis

Vries

Fan

Tscheng³

et al. 2023

Journal of Patient Safety and Risk Management

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Objectives Drug theft by healthcare workers is a recognized problem in emergency departments (EDs) that can lead to patient, healthcare worker, and organization harm. Diversion takes various forms, including tampering with syringes, pilfering from waste containers and falsely documenting drug administration. Before implementing risk-mitigating interventions, we need a detailed understanding of the vulnerabilities in ED medication-use processes. This study sought to identify the critical failure modes (CFMs) within EDs that increase diversion risk and characterize the system factors contributing to CFMs. Methods Between June 2018 and February 2019, we conducted observations in two Ontario EDs. Observers recorded tasks carried out by nurses, pharmacists, and physicians. We performed a Healthcare Failure Mode and Effect Analysis, informed by the observation data, to proactively identify CFMs in the medication-use processes. Failure modes were coded for their effects on diversion risk and the contributing system factors. Results We identified 28 CFMs that increase diversion risk by enabling inappropriate access to controlled substances or compromising documentation. CFMs are multifactorial, stemming primarily from factors related to person (e.g., intent to divert) and tools/technology (e.g., limited automatic reconciliation of records), followed by organization (e.g., practices that diffuse accountability), environment (e.g., workspaces that obscure illicit behaviours), and task (e.g., unstructured processes leading to lapses). Conclusion The study findings inform opportunities to revise vulnerable processes and bolster safeguards, decreasing diversion risk and protecting patients and healthcare workers.

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Section: Introductionmentioning

confidence: 99%

Critical vulnerabilities for diversion of controlled substances in the emergency department: Observations and healthcare failure mode and effect analysis

Vries

Fan

Tscheng³

et al. 2023

Journal of Patient Safety and Risk Management

View full text Add to dashboard Cite

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Compliance with Recommended Practices for Management of Controlled Substances in a Health Care Facility and Corrective Actions

Videau

Atkinson

Thibault

et al. 2019

CJHP

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ABSTRACT Background: Pharmacists are required to maintain a secure inventory of medications and to ensure proper, safe, and diversion-free dispensing practices. Objectives: The primary objectives of this study were to determine compliance with recommended practices for the management of controlled substances in a mother–child teaching hospital and to identify actions to improve compliance. The secondary objective was to identify steps in the drug pathway for controlled substances and associated failure modes in the study hospital. Methods: This descriptive cross-sectional study used a framework devel-oped by the California Hospital Association (CHA) to assess compliance with recommended practices for the management of controlled substances in hospitals. For each criterion, a research assistant observed practices within the pharmacy, on patient care units, at outpatient care clinics, and in operating and delivery rooms. The level of compliance was recorded as compliant, partially compliant, or noncompliant. An Ishikawa diagram was developed to illustrate steps in the drug pathway and associated failure modes related to the use of controlled substances in the study hospital. Results: The pathway for controlled substances at the study hospital was compliant for 56 (49.6%) of the 113 CHA criteria, partially compliant for 27 (23.9%) of the criteria, and noncompliant for 24 (21.2%) of the criteria; the remaining 6 (5.3%) criteria were not applicable. This practice evaluation highlighted 22 corrective actions, 12 (55%) that could be implemented in the short term, 8 (36%) suitable for implementation in the medium term, and 2 (9%) suitable for both the short and medium term. A total of 57 potential failure modes related to the use of controlled substances were identified. Conclusions: The pathway for controlled substances at the study hospital was compliant with almost half of the CHA criteria, and 22 corrective actions were identified. Pharmacists, physicians, and nurses should be mobilized to optimize the use of controlled substances throughout the drug-use process.RÉSUMÉ Contexte: Les pharmaciens sont responsables de maintenir à jour les réserves de médicaments et doivent faire en sorte que les pratiques de distribution soient adéquates, sûres et exemptes de détournement. Objectifs : Les objectifs principaux de la présente étude consistaient à déterminer le degré de conformité aux pratiques de gestion des substances contrôlées, recommandées dans un hôpital universitaire mère-enfant, et de trouver des mesures pour améliorer leur degré de conformité. L’objectif secondaire visait à recenser les étapes que suivent les substances contrôlées dans le circuit des médicaments et les modes de défaillance qui y sont associés dans l’hôpital à l’étude. Méthodes : La présente étude descriptive et transversale s’appuyait sur un cadre mis au point par la California Hospital Association (CHA), qui sert à évaluer le degré de conformité aux recommandations relatives aux pratiques de gestion des substances contrôlées dans les hôpitaux. Pour chaque critère, un assistant de recherche observait les pratiques dans le service de pharmacie, les unités de soins, les cliniques de consultation ex-terne et les salles d’opération ou les salles d’accouchement. Il évaluait le degré de conformité à l’aide d’un des qualificatifs suivants : conforme, partiellement conforme ou non conforme. Un diagramme d’Ishikawa a été conçu pour illustrer les étapes du circuit des médicaments et les modes de défaillance associés à l’utilisation de substances contrôlées dans l’hôpital à l’étude. Résultats : Le circuit des substances contrôlées à l’hôpital où se déroulait l’étude était conforme à 56 (49,6 %) des 113 critères de la CHA, partiellement conforme à 27 (23,9 %) critères et non conforme à 24 (21,2 %) critères; les 6 (5,3 %) critères restants n’étaient pas applicables. Cette évaluation des pratiques a mis en évidence 22 actions correctives, dont 12 (55 %) pouvaient être mises en place à court terme, 8 (36 %) à moyen terme et 2 (9 %) à court ou à moyen terme. Les investigateurs ont repéré 57 modes de défaillance potentiels liés à l’utilisation de substances contrôlées. Conclusions : L’analyse du circuit des substances contrôlées à l’hôpital où se déroulait l’étude a révélé que près de la moitié des critères de la CHA étaient conformes, et 22 actions correctives ont été proposées. Les pharmaciens, médecins et infirmières devraient participer à l’optimisation de l’utilisation des substances contrôlées dans l’ensemble du processus de distribution des médicaments.

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Utilisation optimale des cabinets automatisés décentralisés : le point sur les risques de détournement des substances désignées

Cited by 2 publications

References 6 publications

Critical vulnerabilities for diversion of controlled substances in the emergency department: Observations and healthcare failure mode and effect analysis

Critical vulnerabilities for diversion of controlled substances in the emergency department: Observations and healthcare failure mode and effect analysis

Compliance with Recommended Practices for Management of Controlled Substances in a Health Care Facility and Corrective Actions

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