Use of Automated Controlled Substance Cabinets for Detection of Diversion in US Hospitals: A National Study

Abstract

Purpose

Use of automated controlled substance cabinets (ACSCs) for storage and distribution of narcotics can provide documentation necessary to identify and detect drug diversion. This study investigated how ACSCs are used for narcotic control in US hospitals (including a comparison of detection rates pre- and post-automations) and looked at the difference between hospitals that used ACSCs vs those that did not; it also identified hospital policies related to drug diversion.

Methods

A survey mailed to a national sample of 311 hospitals achieved a 22% usable response rate. Data were entered into an Excel database and analyzed using descriptive statistics; diversion detection rates were calculated per 100 beds. Detection rates were defined as the average number of employees per year that were detected diverting controlled substances over the 3-year period (both pre- and post-ACSC installation); detection rates for those still using manual systems were defined in the same way but only for the 3-year period just prior to the study. Calculation of diversion detection rates were based on respondent estimates of such occurrences.

Results

Over 80% of the respondents indicated that their institution used an ACSC, and 62% provided the necessary information to calculate a diversion detection of 0.36 per 100 beds pre-automation and 1.12 per 100 beds post-automation (P < 0.001). Out of the 19% of the institutions not using ACSCs, 60% provided the necessary information to calculate a diversion detection rate that was determined to be 0.76 per 100 beds. All respondents reported having policies and procedures related to the diversion of controlled substances; however, they varied significantly regarding drug screening practices and specific conditions for the rehire of staff that were detected diverting drugs.

Conclusions

When used properly, with effective checks and balances, ACSCs have the capability to improve detection of narcotic diversion; and thus, may help to decrease diversion of controlled substances by health care professionals.

Keywords

drug diversion automated controlled substance cabinets controlled substance policies and procedures

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