ASHP Chapter 2 Controlled Substance diversion prevention

Question 1

Where is divertion found?

Answer 1

Areas most vulnerable to diversion

Question 2

Area vulnerable to divertion:

Answer 2

1-pharmacy
— secluded areas with a unsecure controlled Substances,
A -compounding area.
B-Receiving area
2-procedural area
—-open access to anesthesia and pain medication
— ability to pull medication without prior order
3-patient home medication

Question 3

Vulnerability in 5 areas:

Answer 3

1-Procurement
2-operations and dispensing.
3-prescribing
4-administration.
5-medication, waste and removal

Question 4

Vulnerability in :
A—Process is often limited to only 1 to 2 people
1-limited oversight.
2-increased opportunity to diversion act
B–access to CS ordering methods
—222 forms
C—-potential for a diversion during transit

Answer 4

-Vulnerability in :Procurement

Question 5

Vulnerability in ——?

1-limited oversight.
2-potential for tampering prior to preparation, return all waste.
3-potential for substitution while compounding and pre-packing

Answer 5

Preparation and dispensing

—Removal from safe, or ADCs

Question 6

Vulnerability in .?
1-prescription pad, theft
2-Fraudulent or altered prescription
3-over prescribing.
4-self prescribing.
5-prescriptions outside of normal scope of practice

Answer 6

Prescribing

Question 7

Vulnerability in:

1-diversion of medication documented as given.
2-administration of an alternative medication.
3-opportunity for tempering doing removal from ADCs
—-cancellation of removal transactions
—-return transaction that access the original pocket

Answer 7

Administration

Question 8

Vulnerability with:?……

1-diversion of expired medicationi
2-waste of unused medication’s
—-partial and whole doses
3-diversion of unsecured waste

Answer 8

Vulnerability with medication, waste and removal

Question 9

What can we do to prevent diversion for security control measures?

Answer 9

1 physical device.

2-diversion detecting and prevention software

Question 10

To prevent for Security control measures :

1-cameras.
2-automated dispensing cabinets

Answer 10

Physical device

Question 11

To prevent for Security control measures under:

1-example Pandora, RxAuditor,ADC reports
2-can we view historic ADC activities by drug or by user
3-diversion monitoring reports
—-proactive diversion
— waste buddies.
—-cancel transactions
4-program powered by artificial intelligent.
—-bluesight ,heliometric, invistic, protenus.
5-integrate information from automated dispensing cabinets, EMR, time clock, purchasing and receiving software
6-automatically, analyze, user, and transactions to identify an outlier

Answer 11

—diversion detection, and prevention software

Question 12

Element of an effect controlled substance diversion programs:

   A-only apply to CII in  retail setting
   B-perpetual inventory for all CS
    C-monthly inventory of all CS in pharmacy.
     D-weekly inventory or shift count in patient care areas

Answer 12

1-Storage

   -lock all CS in pharmacy and patient care area

Question 13

Element of an effective controlled substance diversion program under:

    1-use of single access pockets.pp
   2-blind count 
    3-fridge lock boxes.
     4-External return bins
      5-timely, discrepancy        resolution.
        6-audits of discrepancy resolution appropriateness

Answer 13

Storage:

—-Controlled substance in ADCs

Question 14

Element of an effective controlled substance diversion program:1st

1-tamper evident bags for CS that can’t be sent home.
2-document on control substance administration record (CSAR)if use during patient stay is necessary

Answer 14

Storage:

  Patient home meds

Question 15

Element of an effective controlled substance diversion:
1-limit number of individuals with ordering privilege
2-CSOS
3-secure 222 forms
4-multi-pack locks for 222 dispensation
5-it would use identifying words in PO numbers( usually outside the delivery box) usually can tell

Answer 15

Ordering

Question 16

Element of an Effective Controlled Substances Diversion programs: there are 8:

Answer 16

1-storage
2-ordering
3-Receiving
4-dispensing
5-prescribing
6-audit to monitor CS administration.
7-medication Waste
8-outdated medication.

Question 17

1-verify accuracy before delivery driver leaves.
2-separation of duties.
3-oversight of CS receipt.
4-include 222 and invoice numbers on ADC receipt
5-attach ADC receipt to invoice and 222

Answer 17

Element of an effective control substance diversion program:

-Receiving

Question 18

Element of an effective control substance diversion program:

1- Use of units dose packaging.
2-inspection of prepared products for tampering.
3-ADC compounding function.
4-limit number and type of CS store in patient care areas.
5-sending CS to a patient care area or ADC
—— load in ADC or document on CSARs
——— avoid sending patient specific.
6-Home meds

Answer 18

Dispesing

Question 19

Element of an effective control substance diversion program:

        1-prescription pads, and paper ——lock  all prescription pads ——— individually numbers blanks —— store in ADC  if possible 2-educate staff on prescribing issues —-signs of forgery (handwriting, variation, unusual, abbreviation, different color, ink) —-overprescribed he —-PMDPs 3-effective use of PMDPs —-CDC recommendations
  a-check all prescriptions at     at least once every 3 months
   b-checking all Opioid    prescriptions prior filling 4-some state and facility have specific requirements 5-important consideration —-not all state participate in PMDPs —— data, not always share from one to jurisdiction to the next —— frequency of data uploaded can verify state

Answer 19

Prescribing

Question 20

Element of an effective controlled substance diversion programs:

-Monthly audit of anesthesia records
- include all anesthesia providers in audit
-Monitor appropriate documentation on anesthesia of all CS removed
-Monitor accurate documentation and witness of waste.
-Report findings to relevant parties

Answer 20

Audits to monitors CS administration
Anesthesia audits

Question 21

Element of an effect a Controlled, substance diversion Prevention program:


1-review of all patient records to ensure adequate pain relief
2-interviews with patient not experiencing expected relief

Answer 21

Audit to monitor administration

     Miscellaneous audits

Question 22

Element of an effective controlled substance diversion program:

1-requires a witness for all waste
2-audit waste quantities
3-use of drug disposal systems
4-required documentation of all CS patch, patient control analgesia (PCA) waste
5-use of drug disposal systems
Sharp container

Answer 22

Medication waste

Question 23

Element of an effective controlled substance diversion program:

-1-store in a lock location.
2-segregate from other CS storage
3-locked on pepetual inventory
4-include in all CS inventories.
5-reconciliation against reversed distributor report on pepetual inventory
4-include in ALL CS inventories.
5-reconciliation against reversed distributor report

Answer 23

Outdated medication’s

Question 24

1-222 logs
2-monthly controlled substance sale report
3-safe ADC compare report.
4-CSARs and manual inventory.
5-prescriptions
6-compounding.
7-waste.
8-outdated, controlled substance

Answer 24

Chains of Custody methods

Question 25

Chain of custody methods:

1-record dispensation of all 222s
 2-multi pack logs

Answer 25

222 logs

Question 26

Chain of custody methods:

Reconciliation CSnpurchase vs receipt

Answer 26

-
Monthly controlled substance sale report

Question 27

Chain of custody methods:

1-review at least daily
2-reconciliation of CS sent to against received in patient care areas

Answer 27

Safe-ADC Compare Reports i

Question 28

1-sequentially numbered forms
2-pharmacy review of completed forms prior to issuance of the next
3-pharmacy monitors transcriptions of beginning and ending counts

Answer 28

CSAR Manual inventories

Question 29

1-contact providers to verify, suspicious or questionable prescriptions
2-lots of numbered prescription, Pads and paper

Answer 29

Chain of custody

  -Prescriptions

Question 30

Chain of custody methods:
1-use compounding function in a ADC vault to make kits and compounds

Answer 30

Compounding

Question 31

Chain of custody methods:

1-document all waste in a ADC if applicable

Answer 31

Waste

Question 32

1-compare perpetual inventory vs reversge distributor

Answer 32

Chain of custody:

-Outdated controlled substance

Question 33

, there are 8:
1-222 Logs
2– monthly controlled substance sale report
3-safe-ADC compare reports
4-CSARs and manual inventories
5-prescriptions.
6-compounding.
7-waste.
8-outdated, controlled substance

Answer 33

The chain of custody methods