drug diversion prevention committee

When will we learn from past mistakes?

Lauren is one of many Coloradans infected with Hepatitis C from a hospital outbreak in 2009.
Lauren is one of many Coloradans infected with Hepatitis C from a hospital outbreak in 2009.

On July 12th, the New York Post printed an article about some very disturbing issues at a VA facility in Albany. The article illustrates just how bad things can get in a hospital setting. These reports are atrocious.
http://nypost.com/2014/07/12/nurse-exposes-va-hospital-stolen-drugs-tortured-veterans/
But what continues to replay in my mind is the section which outlines a nurse diverting morphine. Apparently, this nurse was withdrawing the pain medication from vials and replacing it with a clear unknown substance. Could have be water or saline. The article states that over the past year this could have occurred more than 5,000 times.

Some 5000 opportunities for patients to go without their pain medication. Some 5000 opportunities to recognize this nurse’s actions and put a stop to it. And countless other patients and hospital employees put at risk. Read more

Lauren Lollini Salutes Joe Perz and the CDC DHQP

Joseph Perz, DrPH, MA Quality Standards and Safety Team Leader for the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention
Joseph Perz, DrPH, MA
Quality Standards and Safety Team Leader
for the Division of Healthcare Quality Promotion,
Centers for Disease Control and Prevention

I have held a special place in my heart for Dr. Joe Perz of the CDC for the last 5 years. Even though we have not met in person, we were introduced in a very peculiar way. You see, Joe was one of the first on the scene to investigate a potential outbreak in Colorado in the spring of 2009. The CDC was called in when it was determined there were two reported cases of hepatitis C from individuals who had surgeries at the same hospital just a day or two apart.

I was one of those two patients. I am eternally grateful to Joe and his colleagues for not only getting to the heart of the outbreak and allowing a broken system to be mended but for offering me a sense of understanding about how I had gotten infected. Along the way, several other healthcare professionals with whom I was in contact scoffed at my insistence that I had been infected during my healthcare procedure—and that many other patients had, too. Ever since this first unusual “meeting,” I have followed the tremendous work of Joe Perz and the CDC’s extraordinary Division of Healthcare Quality Promotion (DHQP). I’m a fan!

It is my privilege and honor to direct loyal readers of HONOReform’s weekly blog—and all people who are interested in joining us to change healthcare for the better—to this great new series of pages on the CDC website. “Risks of Healthcare-associated Infections from Drug Diversion” is a much- and long-needed resource. I encourage all healthcare workers to review this information—and to share it with colleagues.

http://www.cdc.gov/injectionsafety/drugdiversion/

Clearly, drug diversion prevention is a complicated issue. Everyone who is involved in this prevention work knows there is much work in many most of our healthcare systems in the United States that needs to be done. To that end, I have joined colleagues on the HONOReform-led Drug Diversion Prevention Committee. One of our goals is to help host a federal meeting in the fall on this issue.

Because of awareness and education efforts like the one developed by Joe Perz and his brilliant and committed colleagues, we are one step closer to an effective national system that will allow these types of never events a thing of the past.

I pledge to do everything I can to support efforts to prevent drug diversion.

Lauren Lollini Salutes Joe Perz and the CDC DHQP

Joseph Perz, DrPH, MA Quality Standards and Safety Team Leader for the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention
Joseph Perz, DrPH, MA
Quality Standards and Safety Team Leader
for the Division of Healthcare Quality Promotion,
Centers for Disease Control and Prevention

I have held a special place in my heart for Dr. Joe Perz of the CDC for the last 5 years. Even though we have not met in person, we were introduced in a very peculiar way. You see, Joe was one of the first on the scene to investigate a potential outbreak in Colorado in the spring of 2009. The CDC was called in when it was determined there were two reported cases of hepatitis C from individuals who had surgeries at the same hospital just a day or two apart.

I was one of those two patients. I am eternally grateful to Joe and his colleagues for not only getting to the heart of the outbreak and allowing a broken system to be mended but for offering me a sense of understanding about how I had gotten infected. Along the way, several other healthcare professionals with whom I was in contact scoffed at my insistence that I had been infected during my healthcare procedure—and that many other patients had, too. Ever since this first unusual “meeting,” I have followed the tremendous work of Joe Perz and the CDC’s extraordinary Division of Healthcare Quality Promotion (DHQP). I’m a fan!
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