Recommendations for Preventing Medication Diversion and Misuse in Hospice Care: A Modified Delphi Study

Abstract

Context: Recommendations are needed to help minimize the risks of medication diversion and misuse in the hospice setting.

Objective: To identify recommendations that could help prevent medication diversion and misuse in hospice care.

Methods: A modified Delphi method was utilized. An interdisciplinary panel of ten experts engaged in three phases of online and in-person voting regarding recommendations. Consensus for recommendations required a minimum of 80% endorsement by the panel experts. After two rounds of voting and several rounds of informal voting, 15 total recommendations were endorsed.

Results: Fifteen recommendations achieved at least 80% endorsement during the final round of voting. Each of the following recommendation topics received ≥ 80% endorsement, the need to balance prevention efforts with quality care, screening clinical job candidates, family education and screening, medication monitoring, responding to missing/diverted medications, and medication disposal. Panelists rated the Patient & Family Education recommendation as most important (M = 9.7; SD = 0.7) followed closely by Responding to Medication Diversion or Misuse (M = 9.5; SD = 1.1).

Conclusion: These recommendations were created by experts in the field to reduce the risk of medication diversion and misuse. Further steps towards implementation may appropriately reduce these risks.

Keywords: Controlled substances; Delphi; Diversion; Hospice; Misuse; Prevention; Recommendations.