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METHODS:
For the 32 outbreak-associated HCV cases, reported controlled medication use was obtained by reviewing electronic and paper medical records. The actual controlled medication use was quantified using records from the medication dispensing system (Pyxis). Actual medication use per procedure was calculated by subtracting the amount of medication discarded from the amount withdrawn. Any difference between reported and actual medication use was noted as a discrepancy.
We also compared aggregate fentanyl use during a baseline 3-month period before the suspected diverter was employed with a 3-month period during employment.
RESULTS: Among 31 cases that received narcotics in the CCL, there were 41 procedures during November 2010 – May 2012. Six medication discrepancies were identified during the review.
Aggregate use data were provided for 192 procedures pre-employment and 250 procedures during employment. The average use of fentanyl per procedure was 72 micrograms (mcg) during the pre-employment period versus 101 mcg during the period of employment. The average actual fentanyl use among the HCV cases was 226 mcg per procedure, 3.1 times higher than pre-employment and 2.2 times higher than during employment.
CONCLUSIONS: Medical record documentation of controlled medication use does not always match actual use patterns. Reported and actual fentanyl use was higher for HCV case procedures than for other CCL patient groups, and CCL use of fentanyl increased during the period of the alleged drug diverter's employment. These findings support the hypothesis of narcotic diversion. Healthcare facilities should have robust medication monitoring and auditing programs as an additional tool to identify and respond to discrepancies and increased use in real time in order to identify and stop drug diversion.