Three Ways to Address Clinical Burnout and Health Care Drug Diversion

As any health care leader can attest, the stress of COVID-19, clinical staffing shortages, and burnout have taken a measurable toll on hospitals, impacting operations and patients in unforeseen ways, from elective-surgery scheduling postponements to prolonged emergency department wait times.

Ratios of clinicians to patients are becoming even more strained.

Retirements, staff layoffs stemming from vaccine mandates, plus cuts in staffing due to workers testing positive, have led to a rush to hire temporary nurses and other clinicians to handle the current surge in hospitalizations. As of January 9, nearly 137,000 people were reportedly hospitalized with COVID-19 in the United States—more than 5 times as many as were in early July.

But although staffing challenges mean health care leaders may have to shift priorities, one area where they shouldn’t scale back is in their efforts to stop health care drug diversion. If anything, our efforts to fight diversion should double.

Since the onset of the COVID-19 pandemic, a surge in patient volumes and emotionally draining shifts are blamed more frequently for triggering anxiety and other mental health issues, which is correlated with substance abuse and substance user disorder (SUD). Given that addictive substances are easier to obtain in health care settings also raises the risk of diversion.

The implications for organizations are steep: Drug diversion costs the health care industry upwards of $70 billion per year and is linked with the spread of health care acquired infections (HAI) among patients. Between 2005 and 2015, the United States recorded more than twice as many HAI outbreaks (e.g., hepatitis C) than between 1985 and 2005.

More than 8 in 10 health care professionals (82%) know or have met someone who has diverted drugs, according to a 2021 report based by Invistics and Porter Research.

Sadly, instead of prioritizing drug diversion, these conditions are causing many organizations to have fewer resources and controls to prevent diversion. Forty-seven percent of respondents to the most recent Invistics/Porter Research drug-diversion survey revealed staff turnover due to the coronavirus has made it more challenging to track drug diversion, while 38% said resources for investigations were reallocated due to budget concerns.

Health care organizations reported slightly less staff dedicated to their drug diversion programs and investigations, with 45% saying they employed one or more full-time professionals, down from 58% who said the same in 2019.

The health care staff who might be tempted to divert for personal use—or put in a position of reporting their colleagues—deserve better.

The Ripple Effect of the Health Care Staffing Crisis and Burnout

Even before March 2020, health care worker shortages affected organizations. In 2019, the Association of American Medical Colleges, which publishes an annual report on shortages, projected a shortfall of 40,000 to 122,000 physicians —which it revised in June 2021 due to the impact of the coronavirus pandemic. The revised projections appear to be worse than the earlier ones.

Moving into 2022,health care organizations are being pressured from all directions. Hopes of returning to normalcy have eroded recently, while the “Great Resignation” has led to many clinicians rethinking their line of work and voluntarily quitting medicine.

All of these factors have spurred huge wage increases for clinicians and a rise in temporary staffing at health facilities. This is especially concerning, because it could raise the risk of diversion if workers aren’t appropriately vetted with thorough background checks.

Among the clinicians who are staying put, burnout is rampant. As many as 4 in 5 respondents to the third annual Medical Economics Physician Wellness and Burnout survey said they currently feel burned out. And as Peter Grinspoon, MD, author of the memoir Free Refills: A Doctor Confronts His Addiction, noted in a recent blog, burnout “manifests in disproportionately high rates of depression, substance abuse, and suicide.”

These are important things to consider, given that, in 2020, US drug overdose deaths rose by nearly 30% to a record 93,331 national deaths. As we have seen time and again from trends data, what’s happening outside of hospitals reflects what’s happening within them, with dire outcomes for the workers we rely on and love.

In November, the University of Texas Southwestern Medical Center agreed to pay a $4.5 million civil settlement for violations of the Controlled Substances Act that allowed hospital staff to divert fentanyl and other drugs, incidents which ultimately caused the overdose deaths of two nurses on staff.

A New Frontier in Prevention, Detection and Help

Understandably, available resources to address diversion, given these broader challenges, are clearly constrained. Not every health system has the budget to employ enough dedicated drug diversion professionals. But there are a few smart investments and small changes that can significantly reduce hospital systems’ risk of health care diversion and its most dire consequences. For 2022, health leaders should focus on enhancing the following areas:

1. Training and education

New staff training and orientation programs offer an important opportunity to educate incoming workers about everything from safety protocols and compliance to handling the stress of treating COVID patients. And while most staff training includes basic education around drug diversion, health care leaders should ensure they’re emphasizing the consequences of diversion (the potential injuries to patients and colleagues being foremost). Leadership should also ensure help and treatment is available to any staff experiencing SUD. Workers should be encouraged to discuss their own feelings of burnout. There is no shame in asking for help.

2. Internal reporting

Abating diversion starts with awareness and transparency. Clinical supervisors should stress that the potential patient harm and legal ramifications connected to diversion impact everyone. Education needs to address the pervasive “don’t ask, don’t tell” culture. Many clinicians are afraid that telling on another worker would affect their colleague’s livelihood, when in fact it might be the best approach for getting that person the help they need, as well as protecting patients.

Training can also include suggestions that about submit anonymous tips to HealthcareDiversion.org.

3. Technology

A growing number of health care professionals are investing in advanced technology systems to track medication within the supply chain, and to detect when those medications are diverted. While nearly 9 in 10 health care leaders (86%) say their organization uses automated dispensing cabinets, and many use security cameras or auditing solutions, these standalone technologies aren’t sufficient in detecting the patterns and behaviors associated with diversion.

What health care organizations need is solutions that enable them to consolidate data from multiple IT systems—electronic medical records, practice management systems, medication-dispensing cabinets, employee time clocks, and wholesaler purchasing records. Machine learning technologies and software can pick up on indicators, or patterns, associated with drug diversion.

The more data this software processes, the better its accuracy identifying (flagging) the actual behaviors and patterns associated with diversion, e.g., a combination of inconsistent pain-scale scores when comparing multiple clinicians caring for the same patients.

With fewer hands available to take an “all hands-on deck” approach at hospitals and health centers, health care leaders need to seek out new ways to prevent diversion. Enhancing education, reporting, and technology tools can go a long way in helping health systems strengthen their defenses against drug diversion, so they can continue to focus on what’s most important: Providing care to patients.

About the Author

Tom Knight is the Founder and CEO of Invistics, the leading provider of advanced inventory visibility and analytics software across complex healthcare systems and global supply chains. Visit invistics.com for more information.