Understanding the Social Networks That Contribute to Diversion in Hospital Inpatient Pharmacies: A Social Network Analysis

Overview

Journal Explor Res Clin Soc Pharm

Date 2024 Nov 11

PMID 39525040

Authors

Troy Francis

Maaike de Vries

Mark Fan

Sonia Pinkney

Reza Yousefi-Nooraie

Mathieu Ouimet

Valeria E Rac

Patricia Trbovich

Affiliations

Soon will be listed here.

Abstract

Background: Controlled substances (CS) are 'diverted' (stolen) from healthcare facilities via many integrated and diverse mechanisms due to a lack of safeguards. There remains a gap in understanding how healthcare workers (HCWs) leverage their social networks (e.g., their role/tasks and interactions with other roles/tasks) within the medication use process (MUP) that contribute to diversion. Social network analysis (SNA) is an analytic approach used to map and analyze social connections, which can help identify influential interdependence between HCWs and tasks susceptible to drug diversion.

Objectives: To map the social network structures of MUP tasks vulnerable to CS diversion in two Inpatient pharmacies and compare diversion risks by identifying influential tasks and HCWs.

Methods: This was an exploratory sequential mixed methods study conducted in the Inpatient pharmacies at two large hospitals in Toronto, Canada. Initial analysis used previously collected clinical observation data to identify key pharmacy roles and tasks vulnerable to CS diversion. Subsequently, a cross-sectional survey was conducted to collect demographic information on HCWs and assess their engagement in the identified vulnerable tasks. Clinical observations and survey data were used to perform two-mode SNA to identify connections between HCWs and tasks susceptible to drug diversion.

Results: The analysis identified different network structures across both sites but highlighted the importance of strategic Pharmacist or Technician Supervisor oversight to moderate-high vulnerability tasks. Pharmacy technicians were found to be the network's most central actors, while Pharmacists had a more supportive role on the network's periphery, providing oversight. Across both sites, there was strong connectivity between HCWs and tasks, indicating a higher level of security against potential undetected diversion.

Conclusion: By strategically involving Pharmacists or Technician Supervisors, diversion risk can be mitigated through cross-checking and quality control. Through identifying the network structure of each unit, hospitals can identify opportunities for future interventions to prevent diversion.

References

Fan M, Tscheng D, Hamilton M, Hyland B, Reding R, Trbovich P . Diversion of Controlled Drugs in Hospitals: A Scoping Review of Contributors and Safeguards. J Hosp Med. 2019; 14(7):419-428. DOI: 10.12788/jhm.3228. View

Clark J, Fera T, Fortier C, Gullickson K, Hays A, Murdaugh L . ASHP Guidelines on Preventing Diversion of Controlled Substances. Am J Health Syst Pharm. 2022; 79(24):2279-2306. DOI: 10.1093/ajhp/zxac246. View

Gale N, Heath G, Cameron E, Rashid S, Redwood S . Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013; 13:117. PMC: 3848812. DOI: 10.1186/1471-2288-13-117. View

Essien U, Ifidon A, Sue K . Black Pain Matters: Prioritizing Antiracism and Equity in the Opioid Epidemic. J Hosp Med. 2021; 16(10):638-639. PMC: 8494278. DOI: 10.12788/jhm.3703. View

Madadi P, Hildebrandt D, Lauwers A, Koren G . Characteristics of opioid-users whose death was related to opioid-toxicity: a population-based study in Ontario, Canada. PLoS One. 2013; 8(4):e60600. PMC: 3618438. DOI: 10.1371/journal.pone.0060600. View

Siriwardena A . Understanding quality improvement through social network analysis. Qual Prim Care. 2014; 22(3):121-3. View

Francis T, Davidson M, Senese L, Jeffs L, Yousefi-Nooraie R, Ouimet M . Exploring the use of social network analysis methods in process improvement within healthcare organizations: a scoping review. BMC Health Serv Res. 2024; 24(1):1030. PMC: 11376022. DOI: 10.1186/s12913-024-11475-1. View

Harris P, Taylor R, Minor B, Elliott V, Fernandez M, ONeal L . The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019; 95:103208. PMC: 7254481. DOI: 10.1016/j.jbi.2019.103208. View

Mc Donnell C . Opioid medication errors in pediatric practice: four years' experience of voluntary safety reporting. Pain Res Manag. 2011; 16(2):93-8. PMC: 3084410. DOI: 10.1155/2011/739359. View

10.

Benham-Hutchins M, Effken J . Multi-professional patterns and methods of communication during patient handoffs. Int J Med Inform. 2010; 79(4):252-67. DOI: 10.1016/j.ijmedinf.2009.12.005. View

11.

Lawrence C, Dunkel L, McEver M, Israel T, Taylor R, Chiriboga G . A REDCap-based model for electronic consent (eConsent): Moving toward a more personalized consent. J Clin Transl Sci. 2020; 4(4):345-353. PMC: 7681162. DOI: 10.1017/cts.2020.30. View

12.

Samarth C, Gloor P . Process efficiency. Redesigning social networks to improve surgery patient flow. J Healthc Inf Manag. 2009; 23(1):20-6. View

13.

Valente T . Network interventions. Science. 2012; 337(6090):49-53. DOI: 10.1126/science.1217330. View

14.

Yousefi Nooraie R, Khan S, Gutberg J, Baker G . A Network Analysis Perspective to Implementation: The Example of Health Links to Promote Coordinated Care. Eval Health Prof. 2018; 42(4):395-421. DOI: 10.1177/0163278718772887. View

15.

Bouchard M, Hashimi S, Tsai K, Lampkin H, Jozaghi E . Back to the core: A network approach to bolster harm reduction among persons who inject drugs. Int J Drug Policy. 2017; 51:95-104. DOI: 10.1016/j.drugpo.2017.10.006. View

16.

Berge K, Dillon K, Sikkink K, Taylor T, Lanier W . Diversion of drugs within health care facilities, a multiple-victim crime: patterns of diversion, scope, consequences, detection, and prevention. Mayo Clin Proc. 2012; 87(7):674-82. PMC: 3538481. DOI: 10.1016/j.mayocp.2012.03.013. View

17.

Friedman S, Neaigus A, Jose B, Curtis R, Goldstein M, Ildefonso G . Sociometric risk networks and risk for HIV infection. Am J Public Health. 1997; 87(8):1289-96. PMC: 1381088. DOI: 10.2105/ajph.87.8.1289. View

18.

Nundy S, Cooper L, Mate K . The Quintuple Aim for Health Care Improvement: A New Imperative to Advance Health Equity. JAMA. 2022; 327(6):521-522. DOI: 10.1001/jama.2021.25181. View

19.

Rice E, Holloway I, Barman-Adhikari A, Fuentes D, Brown C, Palinkas L . A Mixed Methods Approach to Network Data Collection. Field methods. 2014; 26(3):252-268. PMC: 4184035. DOI: 10.1177/1525822X13518168. View

20.

Zakimi N, Greer A, Bouchard M, Dhillon A, Ritter A . Sociometric network analysis in illicit drugs research: A scoping review. PLoS One. 2023; 18(2):e0282340. PMC: 9970099. DOI: 10.1371/journal.pone.0282340. View