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                                                     Initial Post

                                                 Improving Quality

The IOM recommends that policy makers, health care leaders, clinicians, regulators, purchasers, and others are urged to adopt a shared vision for health care that focuses on closing the quality gap between what we know to be good health care and the health care that people actually receive. The report recommends a redesign of the American health care system by providing six “Aims for Improvement”:   Of the six aims, Drug diversion is best categorized by the “aims” is safety and is defined by avoiding injuries to patients from the care that is intended to help them. Drug diversion is defined by the use of prescription medications that are acquired or ingested illegally.  In recent years, the problem of opioid addiction has reached epidemic proportions and has been one of the largest contributors to the rise in diversion incidents.  Diversion involving healthcare providers can result in a various types of patient harm. Diversion poses substantial risk not only to the individual who is diverting the drugs but also to patients, co-workers, and employers. The president of Pharmaceutical Diversion Education estimates that there are approximately 37,000 incidents of drug diversion throughout the heath care system and can result in several types of patient harm including; substandard care due to having an impaired provider, tampering with medication administration – especially, those for pain, and increased risk of infection. The CDC, state, and local health departments have combined efforts to investigate the incidents of infection stemming from drug diversion activities that involved healthcare providers who tampered with injectable drugs.  The findings showed Nearly 30,000 patients were potentially exposed to bloodborne pathogens and were referred for testing. However, no data is available that precisely defines the extent of every type of drug diversion in the health care workplace. Patient safety and professional safety all demand effective, reliable safeguards to maintain the integrity of prescription drugs and controlled substances. Improvements are needed in drug monitoring systems. Greater awareness and specialized training in the area of addiction can help to ameliorate drug diversion. There are many actions health care providers can take to ensure the safety of drug administration. One strategy being developed by the pharmaceutical industry is to reformulate frequently abused drugs into abuse-deterrent preparations. Additionally, The National Pharmaceutical Drug Misuse Framework for Action established a plan aimed at improving the quality use of medicines and reduce the potential for misuse. A goal of the Foundation, is to provide a medication monitoring system for prescribers and pharmacists with real-time access to information on prescriptions for controlled substances.  As nurses, educators, managers and co-workers, we can be more vigilant in our efforts to prevent, detect, and report any suspected diversion. Several key areas such as improved systems for medication management, greater support for prescribers and pharmacists, education and improvement of health literacy, harm reduction and improved regulation are all a part of the solution.

Reference 

Australian Government National Drug Strategy. National Pharmaceutical Drug Misuse Framework for Action (2012-2015). Canberra: NDS; 2013. www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/drug-mu-frm-action [cited 2015 Sep 7]

CDC (2013). Risks of Healthcare-associated Infections from Drug Diversion. Retrieved from https://www.cdc.gov/injectionsafety/drugdiversion/index.html

Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National

Inciardi JA, Surratt HL, Kurtz SP, Burke JJ. The diversion of prescription drugs by health care workers in Cincinnati, Ohio. Subst Use Misuse 2006;41:255-64. [PubMed]

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.

 McGregor C, Gately N, Fleming J. Prescription drug use among detainees: Prevalence, sources and links to crime. Trends and issues in crime and criminal justice. No. 423. Canberra: Australian Institute of Criminology; 2011 Aug.

Pilgrim JL, Yafistham SP, Gaya S, Saar E, Drummer OH. An update on oxycodone: lessons for death investigators in Australia. Forensic Sci Med Pathol 2015;11:3-12. [PubMed]