In early December 2016, a former surgical resident gained access to five ORs, attended patient rounds and even helped transport a patient... all why pretending to be a physician in training!
According to a story in the Boston Globe1, the imposter donned scrubs of the organization and slipped into OR space over the course of two days by "tailgating" other staff members holding open secure doors for each other. The imposter was eventually exposed and escorted off the property without incident. The story goes on to discuss the problem of "tailgating" and the need for staff situational awareness. So, you may be asking "What does this have to do with drug diversion?"
In our previous article "Drug Diversion is an equation: A + O = D2 TM"2, we discussed how Access and Opportunity equals Drug Diversion. This imposter gained Access to a secure area where controlled substances are used in every OR case. What if this individual had hung around after the case as the room was being changed ever for the next case? What if the anesthesia provider had left unattended syringes of controlled substances on top of the cart or left the cart drawer unlocked? This single example illustrates how someone with knowledge of health care facilities and practices can easily infiltrate what is considered to be a highly secure area.
So, again, how secure is your OR? What would your staff do if someone posing as an automated dispensing cabinet technician showed up to "fix" a device in the OR, procedural or peri-operative area? Would staff question the individual, ask for credentials, or verify with Pharmacy? What if you are a smaller facility without 24/7 pharmacy services? The truth of the matter is this has happened in several different cities. Former pharmacy personnel have illegally obtained stolen automated dispensing cabinet keys, come into a facility after hours and gained Access to medication rooms by unsuspecting hospital staff who then left the "vendor" unattended to "fix" the device, creating Opportunity. The "vendor" then unlocked the device, helped themselves to controlled substances, and fled.
A Culture of Trust contributes to the risk for drug diversion3. The above case provides an example of culture of trust undermining the OR security plan. We tend to think people are there to "do the right thing" and we often forget about situational awareness. If someone shows up in a secure area with whom you are not familiar wouldn't it be prudent to ask questions, verify credentials and purpose for being in the secure area? ... Especially after normal hours. In the same article we discussed the Culture of Cater. In the case of the imposter, they suggested connections with an attending physician as a way to gain Access. This could have led to a drug diversion Opportunity had they had intent and waited for the right moment.
These examples serve as stark reminders that areas you think are secure by their nature may in fact be vulnerable. Take the Opportunity to evaluate your gaps and risk points for unauthorized Access. Consider an external resource and fresh perspective to assist. Sometimes our greatest risk points are those we see every day that have become the norm and go unrecognized. An external review can often quickly identify these risk points and help close the gap. In the end, a false alarm is better than a "a three-alarm fire."
1. "The Intruder in the Brigham OR – How Did She Get There?", L. Kowalczyk, The Boston Globe February 5, 2017. Access March 14, 2017.
2. "Drug Diversion is an equation: A + O = D2 TM", G. Burger and M. Burger, Becker's Hospital Review, November 9, 2016.
3. "Drug Diversion: New Approaches to an Old Problem", G. Burger and M. Burger, Am J Pharm Benefits. 2016;8(1):30-33.
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