ALMOST one-fifth of the study drugs provided to medical-surgical departments and emergency departments (EDs) were not administered to patients, with the largest proportion of unaccounted drugs being useful for self-medication.
Professor David Taylor, director of emergency medicine research at Austin Health in Melbourne, and his colleagues have studied the nature, extent and cost of the discrepancies between the quantities of drugs supplied to medical services and those administered to patients in public hospitals in Melbourne, in research published by the MJA.
“Considerable quantities of drugs go unaccounted for in public hospitals,” Taylor and colleagues wrote.
Researchers analyzed electronic pharmacy medication management system (drug supply) and medication administration data for 20 commonly used medications at each of Melbourne’s four public hospitals in 2019.
The data indicated that nearly one-fifth (19.2%) of units provided to medical-surgical and emergency departments were not administered to patients.
“Differences for drugs useful for self-treatment or for treating friends or family, such as oral antibiotics, were relatively high,” Taylor and colleagues reported.
“Our results were also consistent with other reports that the discrepancies were higher for the oral route than for the equivalent parenteral route. [non-oral] drugs, while those of parenteral preparations were probably attributed to wastage.
Although they did not specifically investigate the reasons for the discrepancies, Taylor and colleagues wrote that their findings and others around the world suggested that “medication discrepancies are partly explained by theft, usually for self-treatment”.
“The diversion of controlled drugs by hospital staff has been described, particularly in the perioperative areas of hospital practice.
“The generally low deviation rates for controlled substances in our survey were encouraging, but the high rates of oxycodone and temazepam in individual hospitals are concerning and require elucidation.
“The large discrepancies for ED medications we found likely have multiple causes,” they wrote.
“Medicines are often transferred from emergency departments to other rooms or departments, bypassing supply and administration systems, particularly during off-hours, when a medication may not be immediately available. available in a particular room.
“Patients discharged to hospital at home can be given parenteral drugs to ensure continuity of treatment before a definitive source is secured, and doctors can provide discharged patients with starter kits or full courses of drugs at the place of orders.
“Additionally, prescription drugs are sometimes provided from the emergency department’s drug advance instead of the after-hours drug facility for discharged patients.
“The relatively hectic environment and larger emergency services staffing may also contribute to the discrepancies.”
Other possible explanations for discrepancies include failure to document medication administration, failure to document verbal orders, temporary unavailability of the medication record system, undocumented preparation and administration errors, changes in advance drug levels, stock recalls, spills, waste, and drug expiration.
“We recommend that the integrity of electronic drug supply and administration data be validated, by comparing electronic audit data to manual audit data,” Taylor and colleagues concluded.
“The reasons for medication discrepancies need to be investigated to facilitate the development of appropriate targeted interventions, including staff training, strict administration approval and audit procedures, and better tracking of medications transferred into services, given to patients or other services, or not used for other reasons.
“Cameras in medication rooms could be considered and procedures to prevent diversion and harmonize supply and use could be reviewed.
“Our findings underscore the importance of monitoring discrepancies between electronic drug supply and dispensing data to improve drug loss detection and prevention.”
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