Diversion Quarterly — Q3 2020

Olivia StearnBlog

Kit Check is sharing data from its Bluesight™ for Controlled Substances platform on a quarterly basis to provide insight into the types of diversions and investigations that may be occurring in hospital pharmacies. The following information is as of September 30, 2020. Data was pulled from health systems across the United States.

Commentary from the CEO

“With the COVID-19 pandemic worsening America’s opioid crisis, it’s more crucial than ever for hospitals to keep a sharp eye on drug diversion,” said Kevin MacDonald, CEO of Kit Check. “Tracking variances is imperative in fighting the opioid epidemic as a second COVID-19 wave looms and an increasing number of employees are flagged for exhibiting anomalous activity. Bluesight for Controlled Substances has reviewed more than 15 million cases and continues to provide valuable insights into drug diversion.”

Totals

Numbers based on Kit Check’s earliest data available.

  • Cases: 15,555,761
  • Cases automatically closed (no variance): 13,837,844 or 89%
  • Cases with variance: 1,675,458 or 11%
  • Cases with variances reviewed: 641,115
  • Cases with variances reviewed, but unable to reconcile: 145,975
  • Of the 11% of overall cases with a variance:
    • 10% of cases involving an RN contained a variance
    • 10% of cases involving a physician contained a variance
    • 18% of cases involving an anesthesiologist contained a variance

Top Drugs That Make Up Variances

  • Fentanyl (24% of total)
  • Midazolam (13%)
  • Hydromorphone (11%)
  • Morphine (11%)
  • Lorazepam (8%)
  • Oxycodone (7%)
  • Acetaminophen-Hydrocodone (5%)
  • Ketamine (3%)
  • Propofol (3%)
  • Tramadol (2%)

Investigations

Since April 2019, a total of 1,014 provider investigations have been opened. There are currently 70 hospital systems using the Bluesight investigations feature with an average of 14 cases per hospital, and 20 confirmed diverter cases overall.

Resolution Time

Investigations averaged 33.3 days from open to close.

Users Identified Who Have Stopped Working

To date, 4,294 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

  • Variance – a discrepancy between a medication order and the administration of the medication
  • 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.