Diversion Quarterly — Q1 2020

Jenny HarlettBlog

Kit Check is pulling data from its Bluesight™ for Controlled Substances platform on a quarterly basis that will provide insight into the types of diversions and investigations that may be occurring in hospital pharmacies. The following information is as of March 31, 2020. Data was pulled from health systems across the United States.

Totals

Numbers based on Kit Check’s earliest data available.

  • Cases: 8,990,257
  • Cases automatically closed (no variance): 7,880,612 or 88%
  • Cases with variance: 1,067,172 or 12%
  • Cases with variances reviewed: 366,913
  • Cases with variances reviewed, but unable to reconcile: 94,170
  • 11% of cases involving an RN contained a variance
  • 19% of cases involving an anesthesiologist contained a variance

Top Drugs That Make Up Variances

  • Fentanyl (23% of total)
  • Midazolam (13%)
  • Morphine (12%)
  • Hydromorphone (12%)
  • Lorazepam (8%)
  • Oxycodone (8%),
  • Acetaminophen-Hydrocodone (6%)
  • Propofol (3%)
  • Ketamine (3%)
  • Tramadol (2%)

Investigations

Since April 2019, a total of 422 investigations have been opened. There are currently 40 hospital systems using the Bluesight investigations feature, averaging 11 investigations per customer.

Resolution Time

Investigations averaged 22.6 days from open to close.

Users Identified Who Have Stopped Working

1,993 employees who were designated as red/orange (indicating highly anomalous activity) in Bluesight’s Individual Risk Identification Score (IRIS) feature stopped working at that hospital.

Definitions

  • Case – a dispense/administration of a controlled substance (and in some cases other non-controlled medications) with an accounting of any medication wasted or returned.
  • Cases automatically closed – a controlled substance dispense that followed the expected patterns of administration and waste, allowing Bluesight to automatically close the case with a full account of the medication dose (no amount of the drug missing).
  • Cases with variance – a controlled substance dispense followed by an unexpected pattern of administration and waste, allowing Bluesight to flag the case for manager (pharmacist or nurse manager) review as a variance (whole or partial amount of medication missing).
  • Cases with variances reviewed – a flagged variance that a manager is able to manually close with more information.
  • Cases with variances reviewed, but unable to reconcile – a dispense that remains a variance after manager review, elevating the transaction for more scrutiny.