Vaccinations Ramp Up

Putting the spotlight on drug security and how technology can aid

• By Paul Baratta
• June 01, 2021

Protecting drugs, medications and supplies within a healthcare setting is a vital assignment. When licit and medically necessary drugs are taken and used for illicit purposes, it’s called drug diversion — and it has far-reaching consequences. It can be a life-or-death matter, which is why there are guidelines from the American Society of Health-System Pharmacists (ASHP) for preventing diversion of controlled substances. These guidelines include core administrative elements, system-level controls such as monitoring and surveillance, and provider-level controls.

Drug Diversion

When healthcare employees steal prescription medicines or controlled substances, such as opioids or even the COVID-19 vaccine for their own use or to sell — puts patients at risk, according to the Centers for Disease Control and Prevention (CDC). This manifests in several ways, including substandard care delivered by an impaired healthcare provider; denial of essential pain medication or therapy; and risks of infection if a provider tampers with injectable drugs, the CDC describes.

There can be financial consequences for healthcare providers, as well. In May 2018, the U.S. Attorney’s Office, Southern District of Georgia, announced that Effingham Health System, Springfield, Ga., had agreed to pay the United States $4.1 million to “resolve allegations that Effingham Health System failed to provide effective controls and procedures to guard against theft and loss of controlled substances, leading to a significant diversion of opioids, and failing to timely report the suspected diversion to the Drug Enforcement Administration (DEA).”

The incident was thought at that time to be the nation’s largest settlement of its kind involving allegations of drug diversion at a hospital. U.S. Attorney Bobby L. Christine said in the announcement, “Hospitals must adopt and maintain effective safeguards as a bulwark against diversion — the risk to the public is simply too great to accept anything less than what the law demands.”

The Joint Commission, an independent, not-for-profit group in the United States that administers voluntary accreditation programs for hospitals, stated that “only a fraction of those who are diverting drugs are ever caught, despite clear signals….” This leads to the importance of having a controlled substances diversion prevention program (CSDPP), a guideline that is provided by the ASHP.

“Ultimately, each organization is responsible for developing a CSDPP that complies with applicable federal and state laws and regulations but also one that applies technology and diligent surveillance to routinely review process compliance and effectiveness, strengthen controls, and seek to proactively prevent diversion,” the guideline states.

The Joint Commission emphasizes that there are three essential components that healthcare organizations must consider when dealing with drug diversion: prevention, early detection and appropriate response. Under the heading of early detection is the topic of having systems in place such as video monitoring of high-risk areas like pharmacies.

Central Fill Pharmacy

Most hospitals have a state-authorized central fill pharmacy, where controlled substances are amassed and then may be distributed to satellite pharmacies throughout the hospital, such as at autonomous dispensing machines called Pyxis MedStations. Hospitals have a process for moving narcotics from the central fill pharmacy to the machines on various hospital floors — for example, the drugs may need to be escorted by at least two pharmacists and sometimes a security officer.

Every hospital has a mandatory policy that provides for a security management program. In that policy, the hospital must identify its “sensitive areas,” one of which is pharmacies. Once an area is identified, then security must be added, minimally with 24/7 video surveillance and restrictive access control. O en chemotherapy and other medication is prepared in the central fill pharmacy, making it necessary for the hospital to videorecord all activities within.

Traditional video can be enhanced with analytics and network audio to make it a proactive security tool. The analytics can “predict” security concerns in real time, while the network audio can extend the reach of the surveillance system to give it not only “eyes,” but “ears.”

There is always a risk of somebody trying to forcibly enter a sensitive area in a hospital, so security cannot be understated. When a visitor presses a button on an intercom or network door station to request entry, the person on the other side can see and speak to the visitor. Cameras should be on both sides of the door, and there should be a second camera in the hallway leading to the pharmacy door, so the pharmacist can observe that the visitor is alone before granting access.

Dispensing Locations

To address the problem of drug diversion that could be occurring via the dispensing machines on nursing floors, video surveillance should be installed to monitor them.

This security practice is becoming more common today than it was five years ago.

While the machines themselves have several built-in methods to catch discrepancies that may indicate diversion, the actual video footage would be called upon if an internal investigation is necessary based on discrepancy reports or other factors. An internal investigation could involve the head of pharmacy, the head of security, human resources, and risk management.

Network audio speakers also could be added — and have been at several major hospitals — simply as a deterrent to remind visitors that they are loitering too closely to a dispensing location. A hospital would set a camera containing an onboard analytic to detect loitering outside of a pharmacy. The camera would see that the person was loitering for perhaps 60 seconds. It would then send an alert to a security officer, which can be helpful for officers who have to watch dozens or even hundreds of cameras. A pre-recorded message would say, “This is a restricted area; please step away.” The same security scenario could be used anywhere within a hospital, especially near emergency exits.

COVID-19 Vaccine Transportation, Sites

Security for COVID-19 vaccines may be the most complex process healthcare professionals have had to deal with in some time — ensuring vaccines are not stolen or tampered with, ensuring there are no disturbances at vaccination sites, and ensuring vaccines are given to the right people. The key to having a successful security program is to focus equally on people, processes and technology.

The COVID-19 vaccination program rolled out in December 2020 and it has been an ad hoc logistical process involving many unusual vaccination sites, including places like county fairgrounds and sports stadiums, in additional to hospitals and pharmacies. These facilities are putting a spotlight on security, as some vaccine thefts and potential thefts have already been reported.

To ensure the safety and security of both healthcare professionals working at remote vaccination sites and people getting vaccinated, a risk assessment should be conducted to address all potential threats and hazards.

The following security measures should be considered as part of the mediation strategy at remote sites:

• Install fencing around the vaccination site.
• Erect barricades to impede a vehicle from penetrating the vaccine structure.
• Use a single point of entry for persons obtaining the vaccines, and equip this entry point with barriers that create a single line for entry.
• Set up a separate employee entrance located away from the vaccination entrance so it’s clear who belongs in the work area.
• Install video surveillance to monitor the patient entrance, employee entrance, waiting line, dispensing area, and parking lot.
• Provide a safe refuge for staff in the event of an adverse event.
• Consider the use of armed personnel or police to patrol or be posted at the dispensing site.

Put processes in place for emergency evacuation of staff for emergency situations or inclement weather. Staff should be given proper training on the process for reporting incidents to either police or an on-site security officer, on active-shooter prevention, and on workplace violence prevention. It is important to know how to quell any problems that could arise at the vaccination site.

Put processes in place for the transportation of vaccines. Video surveillance cameras should monitor vaccine shipments from the time they arrive at a loading dock to ensure that healthcare professionals are able to track when the shipment arrives, that it has not been tampered with, and to have footage to use as a reference to the timestamps for monitoring the length of time it takes for the vaccines to go from dock to freezer.

A good recommendation for a loading dock is a 360-degree, multi-lens camera unit with a PTZ camera below it. With an integrated solution including a radar sensor and network audio, not only will the facility be able to video-track the actual shipment across an entire surveillance network (which could span a multi-block area), but they can create a scenario in which all of the relevant close-up detail is captured automatically by the system, regardless of whether the cameras are being watched.

The vaccine supply should be stored in a secure location, preferably locked and requiring two-person authentication. If secure storage is not possible, then the area should be surrounded by physical barriers to restrict access. Healthcare providers should make sure there is a process in place for transferring the vaccine supply to an alternate storage site in the event of power loss or refrigerator failure.

Dome cameras work well for the refrigeration units that are housing the vaccines and can include a built-in heater if needed. An access control unit with an audible alarm should be installed, as well. A network door station that combines video surveillance, two-way communication and remote entry control in a single device also can provide effective protection for secured vaccination storage rooms.

The ultimate goal is trust and security.

Many people depend on the integrity of the processes that protect the drugs that are administered to them. Security professionals have a responsibility to adhere to the requirements to warrant that trust.

This article originally appeared in the May / June 2021 issue of Campus Security Today.