This post was originally published on this site
RICHMOND, Ind. — Reid Health and another Indiana hospital have been ordered to appear before the Indiana Pharmacy Board to explain what they are doing to guard against opioid diversion.
Both Reid and Hendricks Regional Hospital in Danville are being summoned to hearings on Feb. 12 concerning the thefts of opioids by nursing staff.
The hospitals have been ordered to show cause why the renewals of their state Controlled Substance Registrations should not be denied. A CSR is needed to prescribe controlled substances in the state of Indiana.
The pharmacy board has the authority to impose sanctions including letters of reprimand, fines, probation and license revocation. The latter seems highly unlikely because both hospitals already have taken corrective action, such as installation of surveillance cameras, training on substance abuse in the workplace, and closer review of inventory.
Based on “numerous incidents of diversion,” Reid was cited by the Drug Enforcement Administration for “failure to provide effective controls and procedures to guard against theft and diversion of controlled substances … “
On the day that Reid finally caught up with nurse Michelle Hibbard, in January of 2017, she was a walking pharmacy.
Asked to empty the pockets of her scrubs, Hibbard produced seven vials containing fentanyl and hydromorphone. In addition, a strip search uncovered a blister pack containing a hydromorphone tablet, a tourniquet, a needle and two vials of hydromorphone in her underwear, according to the complaint.
Hibbard also admitted that she had consumed another vial of fentanyl by squirting it into her mouth. Hospital records showed that she stole nearly 900 units of medication valued at about $72,000 over the course of nearly half a year. She eventually pleaded guilty to criminal charges.
At Hendricks Regional, a nurse diverted 1,388 mg of hydromorphone over a period of three months.
“The order-to-show-cause hearing is the mechanism the board uses to review positive responses on CSR applications-renewals,” said Meredith Lizza, spokeswoman for the Indiana Professional Licensing Agency. ” … the board does not have many hospitals that answer ‘yes.’ “
Both hospitals answered “yes” to, ” … has there been an occasion where any agent of your facility has not maintained effective controls against diversion of controlled substances …?”
Reid declined comment for this article.
The DEA quoted senior pharmacy officials at Reid as saying that in the summer of 2016, reports, including proactive diversion reports, stopped being generated for review of controlled substance activities related to the hospital’s automated-medication dispensing systems.
“This failure was not discovered until Hibbard was arrested for diverting controlled substances in January 2017,” the DEA reported.
To correct the problem, weekly dispensing-system reports are now reviewed for unusual activity; Reid began discussing the possibility of system-wide, random drug testing; cameras were being pursued; and staff received “substance abuse in the workplace” training, Reid’s pharmacy director, Brad Hester, wrote in a letter on April 20 to the DEA.
Hendricks Regional began subscribing to and using Omnicell’s Pandora Analytics software to improve detection of drug diversion; re-educated staff; installed high-definition cameras; and increased reporting after its pharmacy discovered a nurse’s diversion.
Hendricks Regional issued this statement on Tuesday:
“Hendricks Regional Health is undergoing the routine, bi-annual renewal process of the Controlled Substance Registration with the Indiana Board of Pharmacy. HRH is committed to complying with standards set by the Board of Pharmacy.”
“Each nurse has their own philosophy on pain-medication administration,” Lorie A. Brown, an Indianapolis attorney and nurse, told The Star Press. “Some like to stay on top of the pain and others only give it when absolutely necessary. It would be helpful for each unit to have a united philosophy about the administration of pain medication.”
Nurses need to be trained on the warning signs of addiction, she added, citing the ISNAP or Indiana State Nurses Assistance Program’s warning signs, including inappropriate behavior at work, mood swings, increased or unexplained absenteeism, deteriorating appearance and job performance, poor judgment and concentration, and frequent lying.
“The hallmark sign of addiction is denial,” Brown said. “Licensed health professionals are experts at minimizing the problem and convincing others that everything is under control … I think much more needs to be done to prevent and detect this problem. Many nurses still don’t even know about ISNAP.”