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.
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
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.
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
- 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 & Life Safety.