Misappropriation of medications and equipment in the emergency department

Hendarto, Andreas; Harding, Andrew M; Kant, Joyce A.; Hunter, Michelle T.; Taylor, David

doi:10.1016/j.auec.2019.01.005

Cited by 3 publications

(7 citation statements)

References 11 publications

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“…Hospitals are struggling with the COVID-19 pandemic, and especially the EDs face all the burden and the risk for the initial identification of COVID-19. Another study revealed the equipment limits, and especially the discrepancy rates for several medications in the ED, that were high even before the pandemic [24]. As a result, in several lowincome countries or those facing a financial crisis, hospitals might not be well equipped for the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

Societal Criticism towards COVID-19: Assessing the Theory of Self-Diagnosis Contrasted to Medical Diagnosis

2021

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Background: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic introducing the mass autodiagnosis via rapid antigen testing methods, and self-tests were important for several populaces, yet with several neglected issues. In addition, hospital diagnosis was a target of many people or media, as the various COVID-19 clinical phenotypes trammel the precise emergency physicians’ response. Methods: A web-based questionnaire was disseminated through social media in the first half of August 2021 in the Greek populace, assessing the societal criticism for autodiagnosis and medical diagnosis and their issues, just before the occurrence of the fourth pandemic wave in the country. Results: Two thirds of the responders characterized self-tests as unreliable and two fifths reported them dangerous. Reliability (OR 1.335; CI 0.060–0.300; p = 0.000) and danger (OR 5.068; CI 3139–8184; p = 0.000) were significant predictors for the population-based sample’s volition for a self-test. Reversely, regarding medical diagnosis, half of the responders reported the lack of reliability and effectiveness in the emergency departments, which had a significant impact on willingness to visit a hospital if needed (OR 3.207; CI 1987–5182; p = 0.000 and OR 3.506; CI 2167–5670; p = 0.000). Conclusions: The importance of community-based questionnaires is highlighted for assessing people’s criticism and improving the highlighted points in several topics.

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Section: Discussionmentioning

confidence: 99%

Societal Criticism towards COVID-19: Assessing the Theory of Self-Diagnosis Contrasted to Medical Diagnosis

2021

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“…Earlier studies 1,7 found relationships between medication diversion and accessibility. As controlled medications are associated with misuse, 4,10 in Australia they are generally stored in a safe and need to be signed out by two authorised staff members.…”

Section: Discussionmentioning

confidence: 95%

“…14 Our findings were also consistent with other reports that discrepancies were higher for oral than equivalent parenteral medications, whereby those for parenteral preparations were probably attributable to wastage. 1 We did not investigate the reasons for the discrepancies. Medication theft by staff 2,5-7 for self-treatment in or outside the workplace has been reported.…”

Section: Discussionmentioning

confidence: 99%

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mentioning

confidence: 99%

“…Electronic medication records, including medication supply and administration data, have facilitated the detection of medication discrepancies. 1 In this study, we analysed electronic medication supply and administration data for a variety of inpatient wards and EDs. Our aim was to describe the nature, extent, and cost of medication discrepancies.…”

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confidence: 99%

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Medication not accounted for in hospital electronic medication administration records: a retrospective observational study

Walker

Harding

Tran

et al. 2021

Medical Journal of Australia

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he quantity of a medication supplied to a hospital ward should closely match the quantity administered to patients. 1 A discrepancy between the amounts supplied and used may reflect medication expiry, wastage, after-hours transfer to other wards, failure to document administration, or theft. 2 In emergency department (EDs), discrepancies have been reported for medications commonly used for self-treatment, and for oral alternatives to parenteral preparations. 1 Unlawful diversion of controlled medications is also a recognised problem. [3][4][5][6][7][8][9] Evaluating medication discrepancies was difficult when records were paper-based, as collating administrative data required a labour-intensive medical record audit. Electronic medication records, including medication supply and administration data, have facilitated the detection of medication discrepancies. 1 In this study, we analysed electronic medication supply and administration data for a variety of inpatient wards and EDs. Our aim was to describe the nature, extent, and cost of medication discrepancies. MethodsWe undertook a multicentre, retrospective observational study in the Austin, Box Hill, Footscray, and Frankston Hospitals in Melbourne, Victoria. The four hospitals are public metropolitan teaching centres with 560, 300, 425, and 401 beds respectively, and their EDs received 90 000, 43 200, 64 604, and 100 616 people in 2019 (according to hospital records).We assessed the quantities of selected medications supplied to two general medical wards, two surgical wards (one general, one orthopaedic) and the ED of each hospital, and the amounts administered to patients during the 2019 calendar year. Medication supply data were extracted from the pharmacy drug management system (MERLIN, PharmHos or iPharmacy, iSoft), and medication administration data from the electronic prescribing system (Millennium, Cerner). Data on doses that were lost, wasted, returned to the pharmacy, or destroyed were not available.For this study, an emergency physician and senior hospital pharmacists purposively sampled medications that are frequently prescribed (eg, for simple analgesia), useful for selftreatment (eg, anti-emetics), are associated with illegal diversion (eg, benzodiazepines), and oral and parenteral preparations of the same or similar medications (eg, oral and parenteral ondansetron). The selection was informed by the results of a pilot study, 1 and was not influenced by medication cost:• Antibiotics ► Phenoxymethylpenicillin (250 mg capsule), benzylpenicillin (1.2 g injection)► Cefalexin (500 mg capsule), ceftriaxone (1 g vial)

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Automatic dispensing cabinets and governance of controlled drugs: an exploratory study in an intensive care unit

et al. 2021

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Background Governance of controlled drugs (CDs) in hospitals is resource intensive but important for patient safety and policy compliance. Objectives To explore whether and how storing CDs in an automated dispensing cabinet (ADC) in a children's hospital intensive care unit (ICU) contributes to the effectiveness and efficiency of CD governance. Methods We conducted a mixed-methods exploratory study, comprising observations, interviews and audits, 3 months after ADC implementation. We observed 54 hours of medications activities in the ICU medication room (with 42 hours of timed data); interviewed nurses (n=19), management (n=1) and pharmacy staff (n=3); reviewed 6 months of ICU incident reports pertaining to CD governance; audited 6 months of CD register data and extracted logs of all ADC transactions for the 3 months following implementation. Data analysis focused on four main CD governance activities: safekeeping/controlling access, documenting use, monitoring, and reporting/investigating. Results Nurses and pharmacists perceived spending less time on CD governance tasks with the ADC. The ADC supported CD governance through automated documentation of CD transactions; 'blind counts'; automated count discrepancy checks; electronic alerts and reporting functionalities. It changed quality and distribution of governance tasks, such as removing the requirement for 'nurses with keys' to access CDs, and allowing pharmacists to generate reports remotely, rather than reviewing registers on the ward. For CDs in the ADC, auditing and monitoring appeared to be ongoing rather than periodic. Such changes appeared to create positive reinforcing loops. However, the ADC also created challenges for CD governance. Most importantly, it was not suitable for all CDs, leading to workarounds and parallel use of a safe plus paper registers. Conclusions ADCs can significantly alter CDs governance in clinical areas. Effects of an ADC on efficiency and effectiveness of governance tasks appear to be complex, going beyond simple time savings or more stringent controls.

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Misappropriation of medications and equipment in the emergency department

Cited by 3 publications

References 11 publications

Societal Criticism towards COVID-19: Assessing the Theory of Self-Diagnosis Contrasted to Medical Diagnosis

Societal Criticism towards COVID-19: Assessing the Theory of Self-Diagnosis Contrasted to Medical Diagnosis

Medication not accounted for in hospital electronic medication administration records: a retrospective observational study

Automatic dispensing cabinets and governance of controlled drugs: an exploratory study in an intensive care unit

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