Centralizing a controlled substance compliance and drug diversion prevention program within a multihospital health system.

PURPOSE: Challenges with monitoring and detecting drug diversion in healthcare facilities continue to be a trending topic amid the opioid epidemic. This article aims to provide insight into the expansion of an academic medical center's drug diversion and controlled substances compliance program. The justification and structure of a multihospital, centralized program are discussed. SUMMARY: Establishing dedicated controlled substances compliance and drug diversion resources has become increasingly common as awareness of the widespread healthcare impact has grown. One academic medical center recognized the value in expanding from 2 dedicated full-time equivalents (FTEs) with a scope of one facility to multiple FTEs with a scope of 5 facilities. The expansion included considering current practices at each facility, establishing the centralized team's scope, gaining organizational support, recruiting a diverse team, and forming an effective committee structure. CONCLUSION: There are multiple organizational benefits from establishing a centralized controlled substances compliance and drug diversion program, including standardization of processes, associated efficiencies, and effective risk mitigation by identifying inconsistent practices across the multifacility organization.

Evaluation and Enhancement of a Comprehensive Controlled Substances Management Process at an Academic Medical Center.

PURPOSE: Controlled substances management is highly regulated, and requires institutions to have processes in place to maintain a closed-loop. This study was conducted to comprehensively evaluate the current state of controlled substances management, propose optimization opportunities, and implement steps to align the medication use process (MUP) to a defined desired state. METHODS: This evaluation was conducted in 2 phases. In phase 1, the current state of controlled substances management was assessed in order to develop a gap analysis tool and failure mode and effects analysis (FMEA). In phase 2, a work group was assembled to address opportunities within the FMEA. The work group prioritized opportunities using the risk priority number (RPN), and formulated action steps to align processes with the defined desired state. RESULTS: Through the literature evaluation, a desired state, consisting of 86 segments, was defined and compared with a gap analysis tool. Direct observation of the MUP allowed for development of 13 process maps depicting current state. Of the 86 segments, it was determined the study institution had a compliance rate of 62%. The remaining 38% correlated with 55 actionable process opportunities that were included in the FMEA. To date, 31 of the 55 (56%) opportunities have been successfully addressed by the work group. CONCLUSION: Use of direct observation to formulate a gap analysis tool and FMEA is an effective modality to evaluate controlled substances processes. These tools allow for pharmacy departments to identify and prioritize opportunities to optimize controlled substances management within an academic medication center.

Serpiginous hypopigmentation secondary to intra-articular corticosteroid injection.

Corticosteroids have been a mainstay of therapy for the treatment of many inflammatory diseases for well over 50 years. Cutaneous side effects of local corticosteroid therapy include striae, thinning of the skin, hypopigmentation, and atrophy, which are well known complications of this treatment modality.Herein, we present an unusual cutaneous adverse side effect rarely seen in intra-articular corticosteroid injections.

Cutaneous Mycobacterium chelonae in a 95-year-old woman.

We present an interesting case of cutaneousMycobacterium chelonae in a 95-year-old woman.The lesion in question was localized to her rightarm; subsequent biopsy and culture studies wereconsistent with a mycobacterial infection. Historically,these infections are treated based on the immunologicstate of the patient. In this case, taking into accountthe age of our otherwise immunocompetent patient,a course of oral antibiotics was initiated. The patientwas unable to tolerate any oral regimens for longerthan several weeks. Remarkably, even in the absenceof recommended antibiotic therapy, the lesionclinically cleared over a course of 8 months.

The Big Five Personality Traits and Intimate Partner Violence: Findings From a Large, Nationally Representative Sample.

Intimate partner violence (IPV) is a major public health concern. Thus, it is vital to identify factors, such as individuals' personality traits, that may place men and women at risk for experiencing IPV. This study used data from Wave 4 of the National Longitudinal Study of Adolescent Health (N = 7,187), to examine the association between the Big Five personality traits and IPV perpetration and victimization among men and women. High openness, extraversion, and neuroticism emerged as the three most important risk factors associated with IPV. Although risk factors were found to be relatively similar for IPV perpetration and IPV victimization, some gender differences emerged, showing that extraversion was only connected to IPV for women but not for men. The present findings may bear important considerations for researchers and practitioners working with individuals and couples affected by IPV.

Closing the empathy gap in college students' judgments of end-of-life tradeoffs.

When considering hypothetical end-of-life (EOL) scenarios involving 80-year-old intensive-care unit patients, young adults are more likely than older adults to judge that shorter lifespan would be a fair trade in exchange for a more pleasant death. This result has been interpreted in terms of an empathy gap, in which individuals fail to relate to the affective states of others. If so, the effect should be reduced when young adults consider scenarios involving patients similar to themselves. The present study examined college students' willingness to trade healthy lifespan for better death in EOL scenarios involving 80-year-old and 22-year-old cancer victims. Results indicated students under 30 were less likely to trade lifespan in the 22-year-old scenarios, and were less likely to trade lifespan in either set of scenarios when the 22-year-old scenarios were presented first. The findings are consistent with an empathy gap account of judgments concerning EOL care.