Authors' objectives:

To undertake a scoping review of the literature relating to:

1. sabotage or tampering, with intent to injure, of equipment or medical products by staff, patients, carers or anyone else with access.

2. solutions that help to minimise the risk of sabotage or tampering.

Literature from fields other than healthcare were considered relevant. The aim of the scoping review was to map the literature relating to sabotage or tampering.

Authors' results and conclusions: A total of 6846 records were identified through the electronic searches, of which one hundred and eighty (180) articles were included. Most were published in the USA. The articles covered various aspects of sabotage or tampering, ranging from establishing the extent of the problem through factors that may cause it, to possible interventions for its prevention and detection. The settings in which sabotage or tampering had been investigated also varied and included clinical practice, the food industry and nuclear sites. Tampering with equipment or drugs or clinical practice: There may be implications for the NHS with regard to patient safety in relation to the tamper-evident tape described in one study, which could be used to seal packs of equipment or drugs that need to be protected from tampering. Similarly, a series of uncontrolled experiments to evaluate the utility of various forms of tamper evident packaging may offer possibilities for the NHS. Two case-control studies are also likely to be of interest, as they identified the theft of narcotics, probably by hospital staff, as a potential danger to patients. In both of these studies adulterants were substituted and the recommendations that came from the studies were that mechanisms to deal with theft of patients medication should be in place, such as hair testing. Other potential implications for the NHS include the findings from one study where a patient had died and it was suspected that this was due to a malicious act. The study was based on a series of laboratory tests and focussed on the accurate detection of digoxin intoxication from post-mortem examination, by measurement of digoxin-like immunoreactive substances (DLIS). Tampering with patient records: The potential for watermarking patient records (either paper or electronic) to prevent or detect tampering was highlighted in one study. Organisational factors associated with sabotage or tampering: The available research literature suggests that frustration and feelings of inequity in the workplace (perceived or otherwise) may be one possible cause of sabotage. Management intervention to handle worker conflict, reduce tension causing situations and promote security awareness was advocated. Tampering with food/water systems: The findings from one study, although not from clinical practice, may be relevant to the NHS. A risk assessment was made of the potential threat of tampering with water systems, which could perhaps be applied in NHS settings to identify areas of vulnerability within hospitals. The other studies did not have direct implications for the NHS but perhaps some of the techniques they described could be applied if tampering with hospital food is suspected. Sabotage at nuclear sites: None of the articles appeared to be of direct relevance to the NHS, however, many of the modelling techniques described could be adapted to develop methods for investigating insider threats of sabotage in NHS facilities.

Authors' recommendations: Overall, the research literature relevant to sabotage or tampering in a health service context is very limited and offers few direct implications for the NHS. The issues considered to be of most relevance, and with potential for further action are outlined below. - Consideration of systems and procedures for the accurate and thorough reporting of sabotage or tampering when it is suspected. - Consideration of the use of alarms or packaging to prevent tampering with equipment or drugs. - Consideration of the use of packaging to detect tampering with equipment or drugs. Suggestions for a future research agenda include investigation of the prevalence of sabotage or tampering across the NHS; the factors that might lead to sabotage or tampering together with the evaluation of interventions to prevent, detect or reduce sabotage or tampering.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/CRD_Reports/crdreport25.pdf

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination