Computerized Controlled-Substance Surveillance
Computerized Controlled-Substance Surveillance
A secondary data-reporting system used to scan the archives of a hospital's automated storage and distribution cabinets (ASDCs) for indications of controlled-substance diversion is described.
ASDCs, which allow access to multiple doses of the same medication at one time, use drug count verification to ensure complete audits and disposition tracking. Because an ASDC may interpret inappropriate removal of a medication as a normal transaction, users of ASDCs should have a comprehensive plan for detecting and investigating controlled-substance diversion. Monitoring for and detecting diversion can be difficult and time-consuming, given the limited report-generating features of many ASDCs. Managers at an 800-bed hospital used report-writing software to address these problems. This application interfaces with the hospital's computer system and generates customized reports. The monthly activity recapitulation report lists each user of the ASDCs and gives a summary of all the controlled-substance transactions for those users for the time period specified. The monthly summary report provides the backbone of the surveillance system and identifies situations that require further audit and review. This report provides a summary of each user's activity for a specific medication for the time period specified. The detailed summary report allows for efficient review of specific transactions before there is a decision to conduct a chart review. This report identifies all ASDC controlled-substance transactions associated with a user.
A computerized report-generating system identifies instances of inappropriate removal of controlled substances from a hospital's ASDCs.
The past decade has seen a rapid increase in the availability and use of patient care unit-based automated storage and distribution cabinets (ASDCs) for pharmaceuticals in the hospital setting. The advent of these computerized storage cabinets (e.g., MedStation, Pyxis Corporation, San Diego, CA, and AcuDose-Rx, McKesson HBOC, San Francisco, CA) has enhanced the pharmacy's ability to track and control medications that must be accessed in the absence of a pharmacist. ASDCs are particularly advantageous for documenting controlled-substance use when perpetual inventories and audit and disposition procedures are necessary to satisfy state and federal regulations. Conventional nonautomated systems require the nurse to log each administered dose and instance of wasted medication on paper. In these manual systems, "shift counts" are necessary -- and are considered drudgery by those involved. Discrepancies that arise in paper-based controlled-substance- tracking systems require painstaking reviews that are often inconclusive because of incomplete or illegible documentation. Investigations of potential drug diversion can be time-consuming and difficult.
ASDCs can enhance audits and disposition tracking for controlled substances by
Despite these control features that automate the pharmacy department's tracking of medication use, overseeing the potential for drug diversion is a function of the department's ability to retrieve information in a manner that identifies areas for further investigation. Pharmacy departments that use ASDCs must take care not to rely on them as the "perfect mousetrap." Data retrieval and review are key components of an ASDC-based surveillance program for controlled substances and are necessary to protect against cases of drug diversion that appear to be legitimate transactions. This article describes a secondary data-reporting system used at one hospital to scan the archive of a hospital's ASDCs for indications of diversion of controlled substances.
A secondary data-reporting system used to scan the archives of a hospital's automated storage and distribution cabinets (ASDCs) for indications of controlled-substance diversion is described.
ASDCs, which allow access to multiple doses of the same medication at one time, use drug count verification to ensure complete audits and disposition tracking. Because an ASDC may interpret inappropriate removal of a medication as a normal transaction, users of ASDCs should have a comprehensive plan for detecting and investigating controlled-substance diversion. Monitoring for and detecting diversion can be difficult and time-consuming, given the limited report-generating features of many ASDCs. Managers at an 800-bed hospital used report-writing software to address these problems. This application interfaces with the hospital's computer system and generates customized reports. The monthly activity recapitulation report lists each user of the ASDCs and gives a summary of all the controlled-substance transactions for those users for the time period specified. The monthly summary report provides the backbone of the surveillance system and identifies situations that require further audit and review. This report provides a summary of each user's activity for a specific medication for the time period specified. The detailed summary report allows for efficient review of specific transactions before there is a decision to conduct a chart review. This report identifies all ASDC controlled-substance transactions associated with a user.
A computerized report-generating system identifies instances of inappropriate removal of controlled substances from a hospital's ASDCs.
The past decade has seen a rapid increase in the availability and use of patient care unit-based automated storage and distribution cabinets (ASDCs) for pharmaceuticals in the hospital setting. The advent of these computerized storage cabinets (e.g., MedStation, Pyxis Corporation, San Diego, CA, and AcuDose-Rx, McKesson HBOC, San Francisco, CA) has enhanced the pharmacy's ability to track and control medications that must be accessed in the absence of a pharmacist. ASDCs are particularly advantageous for documenting controlled-substance use when perpetual inventories and audit and disposition procedures are necessary to satisfy state and federal regulations. Conventional nonautomated systems require the nurse to log each administered dose and instance of wasted medication on paper. In these manual systems, "shift counts" are necessary -- and are considered drudgery by those involved. Discrepancies that arise in paper-based controlled-substance- tracking systems require painstaking reviews that are often inconclusive because of incomplete or illegible documentation. Investigations of potential drug diversion can be time-consuming and difficult.
ASDCs can enhance audits and disposition tracking for controlled substances by
Limiting access to one controlled substance at a time, either through limited-access drawers or single units of issue,
Tracking all the necessary information in a transaction, including patient identification, the employee who accesses the drug, and the date and time of access,
Providing organized and online inventory counts for each item stored and accessed through the system,
Allowing for secured access through user identification and password, magnetic card, or biometric identification, and
Archiving controlled-substance transactions in an electronic database that allows for automated data retrieval and review.
Despite these control features that automate the pharmacy department's tracking of medication use, overseeing the potential for drug diversion is a function of the department's ability to retrieve information in a manner that identifies areas for further investigation. Pharmacy departments that use ASDCs must take care not to rely on them as the "perfect mousetrap." Data retrieval and review are key components of an ASDC-based surveillance program for controlled substances and are necessary to protect against cases of drug diversion that appear to be legitimate transactions. This article describes a secondary data-reporting system used at one hospital to scan the archive of a hospital's ASDCs for indications of diversion of controlled substances.
