How to Conduct Diversion Investigations in the Pharmacy
by Nicole Ary, CPhT
On television shows, it looks to be relatively easy to deal with diversion. Usually, they figure it out in one episode, but investigating diversion cases take a multidisciplinary team, time, and a plan. Generally, you will have a diversion officer or specialist assigned to the case. They then will work with human resources, security (if present), a pharmacy representative (typically the pharmacy manager in retail unless suspected or Automated Dispensing Machine (ADM) specialists in hospitals, nursing management (hospital), risk management/general (legal) counsel, and other specialists such as anesthesia or compliance. For those that do not know, a diversion officer or specialist is often responsible for obtaining all pertinent data for the investigation, interviewing the suspect with a manager or supervisor present, speaking with witnesses, and working with state pharmacy board and DEA officials.
Diversion officers obtain their data in a few different ways. These include auditing and monitoring transactions, visual surveillance, reviewing discrepancies or manual inventory changes, and reviewing unauthorized or unnecessary medication overrides. This is done across the facility. Or in larger retail operations, officers may be assigned specific locations or divisions. Many healthcare organizations use software to help identify trends and run reports to assist in identifying potential diversion, but also still rely on reported suspicious behavior. The data gathered from audits and monitoring is used to help pinpoint an individual or validate their involvement, then the security cameras are reviewed to see if they can be caught in the act. If there are no cameras, the state board or DEA may install hidden ones and check them. They do not provide direct feeds to the officers; however, they will send stills of suspicious activity or the individual carrying out the diversion act. Once the individual has been caught, they will be brought in to be interviewed with management present. In retail, depending on the amount taken, they may be asked to pay restitution on top of being terminated, or they may be charged with felony drug theft and possession.
The interview process should be conducted under a set company standard that has been developed. In addition, the diversion specialist should meet with human resources before the interview to discuss the best process for drug screening if needed. The interviewer should be aware of any substance use assistance programs or other benefits the organization offers, such as an employee assistance program (EAP) or paid rehabilitation. Since interviews can be emotional, it is wise to use a checklist to guide the process and help avoid omissions. Establish a standard method for situations in which the teammate confesses. Consider whether the individual will be asked for a written statement under the circumstances. To expand your understanding of the details, you should ask the following(or something similar)
If the individual does have diverted medication at their home, a plan will need to be created with legal and local law enforcement to retrieve the drugs. If tampering did occur, meaning they did not take a drug but used the medication on site, then a plan would need to be implemented to obtain consent and conduct bloodborne pathogens testing. Any items or medications recovered during the investigation should be maintained by law enforcement and considered evidence.
Once everything is done, you must report the loss due to theft or diversion to the appropriate outside agencies to stay compliant with federal and state regulations. Since each state has different requirements, local reporting requirements must be researched and confirmed before submitting any information from the investigation. The company must also store all information as per state and federal requirements.
- When did the diversion start?
- How did the diversion occur?
- What medications were involved in the diversion?
- Were medications tampered with?
- Were medications withheld from patients?
- Does the individual currently have any diverted medications on their person, their personal property(purse, backpack, etc.), or at their home?