How to do it ... medication management

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Proper and effective medication management of controlled substances can save your facility thousands of dollars in needless waste and diversion. Most solutions are, figuratively speaking, right under your nose if you know where and how to look. Learn how to protect this valued asset, as well as your staff and residents.

Keep supplies of controlled and short expiring substances as low as possible. 

“Many pharmacies now offer short-cycle dispensing,” says Kasumi Oda, director of strategic marketing for Catalyst Healthcare. 

“Reducing refill times for short-term rehab residents has a dramatic reduction on waste and restocking fees,” adds Doc DeVore, director of clinical informatics and industry relations at AOD Software. 

Facilities should reorder needed medications when they have three to five days of supply remaining, adds Rob Taymans, RPh, president of Guardian Pharmacy of Tampa. 

Know the warning signs of drug abuse, most of which are easy to spot if you're paying attention, advises Jodi Dreyer, senior marketing coordinator for Omnicare.

Staff with drug abuse issues are frequently absent, disappear from work, and spend long periods in the bathroom or supply area. Other signs include frequent medication errors, un-administered PRN controlled substances, resident reports of poor pain relief, obsession with e-kits, large amounts of wasted controlled substances and excessive controlled substance sign-outs.

Volunteers and pool nurses who arrive early or late for meds administration or frequently seek overtime or holidays at your facility also could be suspect. Visible clues may include missing vial tops, puncture holes, uneven volumes of liquids/solutions, loose plastic tops on vials that may have been reattached with glue, and empty capsules or capsules covered in powder.

Educate staff and residents about medication costs and safety to help minimize waste. 

For staff, it's as simple as the “right resident, medication, dose, route and frequency, but they must also be mindful of the right rationale, situation, person, documentation and patient's right to refuse,” says Jayne Warwick, RN, director, clinical product consultant for PointClickCare. 

Establish a strict paper trail. Security, metrics and tracking are key to spotting and preventing diversion issues, according to Gayle Tuttle, director of marketing communications for Parata.

“By documenting each medication pass with an accurate date and time stamp, you can track patterns and prevent or stop medication diversion. And make your expectations for this level of detail and visibility clear to your team.”

Each facility should have a defined chain of custody and processes that include reconciling what was ordered to what was received, recording controlled substances into a perpetual inventory, reconciling quantities on hand to the shift count sheet and the medication administration record, and reconciling the number of remaining controlled substance doses to the number destroyed, adds Dreyer.

Harness technology such as software inventory tracking programs and automated dispensing systems.

“Traditional dispensing models used in the post-acute care settings do very little to promote safety and prevent diversion, particularly with emergency drug orders,” says Jason Sutton, DPh, national director of clinical pharmacy services for AlixaRx. 

Consider medication inventory monitoring, access controls, and electronic auditing features to ensure medication safety and reduce diversion. 

Many electronic medical records systems now allow for keeping perpetual inventories of narcotics, adds Taymans. 

Tuttle advises operators to consider tamper-evident and multi-dose strip packaging.

Finally, be proactive. Don't comingle controlled substances with other meds, for example, and establish a policy that requires discontinued controlled substances to be immediately given to a nursing supervisor for double-locked, secured storage, says Dreyer. 

Mistakes to avoid

Ignoring warning signs among staffers, such as frequent medication errors and a lot of waste and controlled substance sign-outs

Carrying large quantities of medications for long periods, especially controlled substances

Not implementing effective paper trails that document inventory and dispensing