Control Substances Diverion Prevention -NPTA Flashcards
The transfers of a controlled substance from a lawful to an unlawful channel of distribution or use
i
What is drug diversion?
There are five frequently, abused drug classes:
Opioids.
Stimulants
Depressants
Anabolic steroids
Hallucinogens
Commonly abused opioids:
Fentanyl
Oxycodone.
Meperidine
Hydrocodone.
Hydrocodone w/acetaminophen.
Hydromorphone.
Morphine.
Codeine
Acetaminophen with codeine
Commonly abused benzodiazepines ( this is a controlled substance often used for anxiety)
Alprazolam
clonazepam
Diazepam
Lorazepam 
-drug regimen consisting of 1 opioid ,1 benzodiazepine ,carisoprodol,
-Independently they provide benefit to the injury patient; however, combined that is a little rationale for a legitimate use
-Therapeutic benefits don’t outweighed the risk of these three medication
-produces euphoria similar to that of heroin and is addictive
-short, duration of action, but rapid onset of action
-In combination, these drugs are synergistic in causing respiratory depression possibility death
-Patience addition of alcohol to “HOLY TRINIY” drugs result in CNS depression
“ HOLY TRINITY “ drugs
What is Chronic, relapsing disorder, characterized by compulsive drugs seeking, continued, use the spy, harmful consequences, and long lasting changes in the brain.
-A complex brain disorder and a mental illness
-what is addiction?
-taking in larger amounts or over a long period then was intended.
-Persistent design or unsuccessful effort to cut down use.
-Time is spent to obtain, use, or recovered from the substance ‘s effect
-craving, or a strong desire or urge , to use the substance
-unable to fulfill major road obligations at work, school, or home due to drug use
What are drug addiction characteristics?
Commonly abused, benzodiazepam :(controlled substance, are often used for anxiety)
Alprazolam
Clonazepam
Diazepam
Lorazepam
Holy trinity drugs
— drug regimen consistent one opioid,one benzodiazepine, and carisoprodol,
— independently they provide benefits to the injured patient; however,  combined that is a little rationale for a legitimate use
— therapeutic benefit, don’t wait the risk
— produces euphoria similar to that of Herion, and is addictive
What is Holy trinity Drugs
—Short, duration of action, but rapid onset of action
— in combinations, this drugs are synergistic in causing respiratory depression possibility y death.
— patienct’s addiction of alcohol to “holy Trinity “drugs result in CNS death, depression.
-electronic database that trucks controlled substance prescription in a state-“.
-provide health authorities, real-time information about prescribing and patient behaviors
-Healthcare providers are able to view a patient prescribing history and should enter prescription information into PD and P
-Pharmacists are required to enter controlled substance prescription into PDMP(
 Patient First date prescriber scribers DEA medication and the date. These PDM programs are used by programs, healthcare, health department, and why 
PDMP
Why are controlled substances diverted? there are three: 
Addiction
recreation used.
Financial gain 
taking in large amount, or over a longer period then was intended. -persistent, desire, or unsuccessful effort to cut down use
-Time is spent to obtain, you shall recover from the substanc e. Effect.
-craving, or a strong desire, or urge to use the substance
unable to fulfill, major role obligations at work, school, or Home due to a drug used
There are many Drugs addiction characteristic -
What is “holy trinity “ drugs ?
-Commonly prescribed by “pill mills
-often and Pharmacist are involved in filling prescriptions from “pill mills”
-patient use multiple pharmacies in feelings for this drug regiment
1- a need for markedly increased amount for the substance to achieve intoxication or desired effects
2-I markedly diminished effect with continued use of the same amount of the substance
What is tolerance?
1-present a physical or psychological symptoms that occur after the stoppage, or reducing the intake of substance.
2-the use of a substance to relieve or avoid withdrawal symptoms
What is withdrawal? 
-chills and sweats
-sleeplessness
-fever
-runny nose.
-Nausea and vomiting.
-Muscle aches, or cramps
-Anxiety
-Elevate blood pressure.
-Delirium
-Hallucination
-Seizures
-
Common withdrawal symptoms
-to feel good
-just scape.
-Perform better at school or work.
-Curiosity.
recreational use for?
Who is diverter?
-someone you least expect it.
-Can be exemplary employees
-Awesome first to volunteer to pick up extra shifts
-Excessive ordering.
-Unsupervised access to dry storage area.
-Unverified verbal orders
-Flexible all the rain.
-forgery
Compounding and repackaging
-typical dosage smaller than stop use.
-Poor verification of dispensing to clinical use.
-Reduced pharmacy oversight or dispensing with introduction of technology.
-Loopholes in the intended use automatic dispenser the cabinet (ADC)
-prepare drugs, unsupervised, and insecure-unsupervised access to drugs stops in patient care area
Healthcare contributor to diversion to control Substances;
It
is prescription drug monitor program?(pDMP) -electronic database that traffic control substance prescription in a state-
-I provide health authorities, real time information about prescribing and patient behaviors-
-Healthcare providers are able to review patient’s prescribing history and should enter prescription information into PDMPs
-pharmacist are required to enter controlled substance prescription into PDPM. (pharmacist required. Enter patients name address of birth, prescriber DA medication, quantity direction date of prescription.
-Used by state insurance programs, healthcare, license board, state health department in law
-What is prescription drug monitor program?(pDMP) ?
Why are controlled substances in divergent?
1-addiction
2-Recreational use
3-financial gain
-taking a large amount all over a long period of time then has the intended.
-Persistent, decide, or unsuccessful effort to cut down use
-continued use despise social or into a personal problem. Callcaused by use.
-Time is spent to obtain, use all recovered from the substance’s effect
-craving, or a strong desire, or urge to use the substance.
-Unable to fulfill major role, application at work, school, or home due to drug use
-social, occupational, or regulation note activities are giving up or reduced due to used.
-Use of the substance is recurrent in hazardous situation such as driving.
-Continued use despite no physical or psychological problems due to drug.
-Tolerance.
-Withdrawal.
Drug addiction characteristic:
-I need for markedly increased amounts of the substance to achieve intoxication or design effect.
-A Markedly diminished effect with continue use of the same amount of substance
What is tolerance?
-presence of physical or psychological symptoms that occur after the stoppage or reducing the intake of substance — do use of a substance to release or avoid withdrawal symptoms.
What is withdrawal?
Common withdrawal symptoms
Chill and sweat.
Sleeplessness.
Fever.
Running nose.
Nager and vomiting.
Muscle aches I’ll cramps.
Anxiety.
Elevated blood pressure.
Elevated heart rate.
Delirium.
Hallucination
Seizures
-to feel good-
-To escape
-perform better at school or work
-Curiosity
What is recreational use ?
-Excessive ordering
-Unsupervised access to drug storage area.
-Unverified verbal orders.
-Flexible ordering.
-Forgery
-Compounding and repackaging.
-Typical those smaller than stocked drugs.
-Poor verification of dispensing to clinical unit
-Reduced pharmacy oversight of dispensing with introduction of technology
-New pose in the intended use of automated dispensing cabinets
(ADC)
-Prepare drugs are unsupervised and unsecure
-Unsupervised access to drug stock in patient care area
-abc may not be ultimately configured, updated, or monitored
-Flexibility in administration
-Falsification of patient documentation
-Visual confirmation of wasting cannot detector content
-falsification of drug expiration
-Present a partially administered drugs or clinical units
-Unsecure waste receptacles (nursing units)
-Complacency in the enforcement of wasting procedures
-Fortification of witnessing of destruction
-
Healthcare contributor to diversion :
-patient receiving the same combination and strength of prescriptions.
-patience with the same diagnosis code written on their prescriptions
-individuals driving long distance to visit physicians and/or fill prescriptions
-customers coming to the pharmacy in groups to feel the same prescription written by the same physician (often happen in sequences)
-Customers pay cash for the prescriptions (no insurance record of this use Rx
What are potential signs of diversion?
-prescription pads are devoted and forged.
-Written prescription altered by patient
-self prescribe controlled substance by prescriber
-Product containers are compromised ( nursing units)
- steps of drug is removed and administered while control substance is diverted
-Vollum remove from Premixed infusion.
-prescription for a controlled substance written by physician, not associate with pain management
-Multidose vial overfill diverted bou
-Prepare syringes content, replaced with ceiling solutions
-drug dispensing machines show discrepancy all overrides
-waste is not adequately witnessed
-Control shops in Waze is removed from unsecure waste container in pharmacy
-Controlled substance waste in syringes replace with saline
-Potential fortification of medical records indicate by:
— late documentation of certain medication only
—-coworkers assistant, others in completing documentation.
-
Healthcare workers potential signs of diversion:
Consequences of diversion 
-patient harm
-Healthcare workers harm
-. Harm to other healthcare workers.
-Organizational liability 
-May experience substandard care from provider.
-May receive less of intended those resulting in poor pain management
-May receive adulterated or contaminated drug
-Loss of trust in healthcare workers
Patient harm
-increased risk of mobility or mortality to healthcare worker.
-unintentional overdose or death.
-Risk of infection
Healthcare worker harmed
-at risk for mechanical injury, or an infection by blood-borne pathogens.
-Share patient care responsibilities might result in adverse patient outcomes.
-Annoying aid they’re addicted, colic by witnessing the disposal of leftover Joseph sent that they did not witness and therefore subject to disciplinary action for failure to follow policy procedure
Harms to other healthcare workers
-loss of revenue do two divided drug
-increase payroll expense due to absenteeism of the addicted healthcare worker-
-Decreased productivity
-Respell civil liability for Fowler to prevent, recognized, or address, signs of drug diversion, or an impaired or addicted employee-
-resources to conduct an investigation required to confirm or refute devotion.
-Mandatory reporting requirement may result being publicize in the media.
-Lack of trust organization.
-Organizational liability
-felony criminal prosecution and civil malpractice actions.
-Professional license, suspension or revocation
Legal issue:
The inability or impending in ability to provide safe, professional activities, and duties due to a behavior, mental, or physical disorder related to alcohol or drug
Impairment
A disease of the brain which is characterized by the recurrent use of alcohol or drugs, that result in function impairment, such as disability, health, problems, and failure to meet responsibilities at home, work, or in school
Substance use disorder
-Generic.
-Mental or physical fatigue
-Injures
-Personal stress
-Physical illness
Psychological.
Stressors contributing to impairment
-neurotransmitter deficits.
-Family history of substance use disorders
Genetic stressors
-staff shortage, many prompt stimulant use-
-Stressful job opportunities.
-Environmental factors.
-Excessive workload.
-Pregnant
-Shift work
-Prolong traveling-
-Sleep deprivation
-Social activities
Mental and physical fatigue stressors
-use of opioid pain medication due to injuries may lead to addiction.
-Chronic pain syndrome .
Injury stressors
-personal relationship issues.
-Family or personal health issues
-Financial matter.
-Addictions, such as gambling and sex
Personal stressor
-disabilities, epilepsy, author, rightists, asthma, cancers, and all the long-term illnesses that result in chronic pain.
-Recurring medical conditions.
-Acute or chronic pain
-
Physical illness stressor
-anxiety
-Depression.
-Low self-esteem.
-Unable to cope with stress
-unfamiliarity of work environment.
-Poor training
Organizational change
-long walk hours
-Shiftwork
-Changing and increasing responsibility
Psychological stressors
-bloodshot eyes.
-Constricted or dilated pupils
-diaphoresis
-fatigue
-hyperactivity , or hypoactivity
-insomnia
-Mood changes.
-Suicidal thoughts
-Running nose
-Sedated.
-sleepiness
-Slurred speech.
Sign of impairment
-track marks.
-Tremors
-Unexplained nausea or vomiting or diarrhea
-Unsteady gait.
-Watery eyes.
-Weight gained or lost
-Anger management issues.
-Defensiveness
-Denial
-Distracted
Isolation.
-Lying
-poor judgment
Signs of impairment
-work absenceeism
-frequent disappear from pharmacy.
/frequent trip to bathroom or drug supply areas.
-Unreliable in keeping appointment and meeting deadlines.
-Work performance which alternates between periods of high and low productivity
-mistakes made due inattention
-ordinary task require a greater effort and consume more time
-Patient or staff complains about healthcare providers, attitude, or behavior
Signs of impairment
-altered order for drugs
-controlled substance discrepancy.
-Frequent correction or medication records.
-Higher than average opioid wastage
-tampering with capsules or vials
Drug diversion behaviors
Patient
-Peers
Professionals.
Institution.
Impairment Effects
Impair effect on patients -
decree trust of health professional.
-Infection from contaminated needles
-Medical errors.
Reaction to run drugs inappropriately
Undue pain. Impair effect on patients
Impair effect on patients -
-discipline from failure to report
-legal liability from share patient for patient care.
-Stress from increased workload as a result of an impaired professional y
-Impairment effects on Peers
accidental injuries
-Billing and insurance fraud
-Communicable infection from the use of unsterile drugs and needles.
-Felony prosecution
-License suspension or revocation
-Heart and liver disease
-Malpractice actions
Impairment effects on professional
-civil liability from failure to recognize an impairment
-decrees institutional reputation
-Decreased revenue from diverted drug
-poor work Quality
-increase absenteeism
-They increased cost of workers compensation
-
Impairment effect on an institution
Addressing Drug Diversion
-preventing diversion:
—-establish process to guard against thefts and diversion and staff education in the methods
—— minimize, unauthorized access or opportunity for tempering and misuse
-Detecting diversion:
——-install system such as video monitors in high risk areas to facilitate in early detection
—— active monitoring of pharmacy and dispensing record data
-responding to diversion
——-establish a culture in which staff the feels comfortably with mantra “see something say something “
Controlled Substances Diversion Prevention program (4)
1-goal of prevention programs
-prevention patient harms
-Prevention diversion related
Addictive illness
-prevention drug related
Death
2- core administrative elements
3-system level controls
4-provider level controls
Core administrative elements
-legal and regulatory requirement
-Organization, oversight and accountability
-human resource management
-automation and technology
-monitoring and surveillance
-investigating and reporting
system level controls
Written employee and provider substance abuse policy
-healthcare, workers education, and awareness program
-supervisor training program
-Employee and provider assistant programs
-Peer support and systems
-Requirements for drug testing, including a for-cause policy for drug testing
-Return to work policy for healthcare worker
-Sanctions for performance and diversion to violations
Human resource management
Responsibly: -
select and implement it all medication related, automated system and technology ( eg, automated dispensing the devices, syringe and infusion pumps, security devices) to ensure they support, diversion control, civilians, and auditing of controlled substances
-System and utilized in a high-risk area with a high volume control substance
-integratesystem in a high risk area
-all healthcare workers are trained regarding the role and responsibility in the use of automation and technology
-Policy and procedure, address, access, security, and documentation in the event of automation downtime system failures
Automation and technology element to support a Controlled Substances Diversion Prevention programs:
-processes for procurement civilians, are followed by all areas that purchase control substance
— perpetual inventory should be conducted on a regular basis.
— automated dispensing device report of you and at least six months by pharmacy
— a process is in please show with resolve controlled substance discrepancy
-poor documentation practice by HCWs is review for possible diversion
Monitoring and surveillance
-investigation are conducted as thoroughly and completely as possible
-The organization established guidelines for engaging, external entities, such as DEA and licensing boards
-DA form 106 should be completed for discrepancy that remain unresolved
Investigation and reporting
-chain of custody.
-Storage and security.
-Internal pharmacy controls.
-Prescribing and administration.
-Returned, waste and disposal
Provider level controls
-method of audit chain of custody of controlled substance.
-Documentation of transport and receipt of control substance.
-Use of secure, lockable, and temper- evident delivery containers
Chain of custody
-controlled substances store in a locked and secure location
-authorized individuals have access to control substance.
-Policy and procedures regarding controlled substance access, including restrictions through assignment, key controls, and the use of passwords.
-Camera civilians used in locations where that is high risk for diversion.
-Automated dispensing device technology should be utilized in high volume control substance area
Storage and security
-safeguards exist that prohibit ordering of control substances by those not authorized
-an electronic controlled substances ordering system (CSOS) is utilize, eliminating on minimizing use a paper DEA form 222s
-Separate purchasing, and receiving roles
-recommend to individual (one to be a pharmacist) count and check, age, control substances, and verify, the order, invoice, and product received documentation matched
-process to investigate and remedy discrepancy when controlled substances are received.
-periodically audit and reconcile vault inventory against purchasing and receiving records
Internal pharmacy controls
-Valid order from an Authorized prescriber exist for all control substances-
-process exists to identify and verify authorized prescribers
-Establish processes to identify unusual or inappropriate prescribing
-Controlled substance packaging is inspected for tampering when being in inventoried
-Policies and procedures address day documentation of controlled substances issued but unused
Prescribing and administration
-control substances overfill is considered an unusable product and is wasted and documented
-Waste container with any unusable control substances secure to preventing tampering
-Expired controlled substances are clearly identified and stored in a separate secure location from other medication’s
Returns, waste, and disposal
-preemployment screening.
-Implement a drug testing program.
-Educate staff.
-Establish dedicated devotions investigation team
Organizational safeguard
Regulatory requirement for reporting drug diversion in healthcare organizations, include the following:
-Drug enforcement administration (DEA) -DEA form 106
-pharmacy board
-Law enforcement
If divertion occurs
Summary:
-Drug diversion occur in our pharmacy setting
-as a healthcare provider, you play vital role in preventing, detecting, and responding to devotion.
-Preventing drug diversion, help deter patient harm, diversion related addiction, and drug related death
