Mitigation for diversion risk medicines within a Queensland hospital and health service: a Delphi consensus approach

Background Diversion‐risk medicines are medicines that may result in serious harm to human health if they are diverted for uses other than their intended purpose. Aim To determine consensus on risk mitigation strategies for non‐Schedule 8 diversion‐risk medicines within a health service and hospital setting. Method A key scoping review and local procedures were reviewed to identify potential risk mitigation strategies. All members of the health service's medication safety governance committee were invited to participate in two rounds of an online questionnaire. For each medicine/medicine class, participants were asked which risk mitigation strategies should be employed. Consensus was set at >75% of respondents choosing a risk mitigation strategy for a particular medicine/medicine class. Ethical approval was granted by the Metro North Health Research Ethics Committee B (Reference no: HREC/2022/MNHB/92193) and the study conforms to the Australian National statement on ethical conduct in human research . Informed consent was obtained from all participants via the distribution of project information sheets, indicating participation was voluntary and all involvement could be withdrawn at any time. Participants provided their consent by completing the survey. Results There were 11 (34%) respondents in survey round 1 and 7 (22%) respondents in survey round 2. Propofol had the largest number of risk mitigation strategies which reached consensus ( n = 8), followed by benzodiazepines ( n = 6). The most common risk mitigation strategy was ‘storage in an area with proxy card restricted access’ ( n = 11 medications), followed by ‘storage within a locked/secure cupboard within a secure medication room’ ( n = 8 medications). Use of closed‐circuit television cameras did not reach consensus for any medication. Conclusion Consultation was undertaken on risk mitigation strategies for diversion‐risk medicines using a multidisciplinary, consensus‐based, multi‐round survey approach. No single or set of risk mitigation strategies that can be uniformly implemented across all diversion‐risk medicine classes was identified. Results have informed a set of risk mitigation principles for non‐schedule 8 diversion‐risk medicines.