Recent media reports describing the diversion of large quantities of narcotics from Alberta pharmacies should serve as a reminder to all pharmacists and pharmacy technicians of the need for the security of drugs under their care. The following best practices are recommended in pharmacies to help create a pharmacy environment in which all narcotics are secured against theft, loss or diversion.
- Implement and maintain a perpetual inventory for narcotics.
- Conduct routine and random narcotic audits frequently and ensure that all identified discrepancies are investigated and resolved.
- After dispensing narcotics with a perceived high-diversion potential, back-count and verify the remaining pharmacy stock against the narcotic’s recorded perpetual inventory.
- Pharmacists performing the final check on narcotic prescriptions filled from log or filled as a part-fill are encouraged to consider the time elapsed since the prescription was logged or last filled. Most legitimate narcotic prescriptions are not kept on hold for extended periods, nor are intervals normally greatly exceeded between part-fills.
- Keep all clutter in the dispensary to a complete minimum. A disorganized dispensary creates an environment in which diversion is more likely to occur and remain undetected.
- Actively review on-hand pharmacy narcotic inventory needs and endeavor to keep smaller amounts of narcotics in stock. Maintaining smaller quantities on hand will allow for a more rapid identification of trends regarding increases in narcotics being received and/or being dispensed. In addition, more periodic narcotic orders resulting from lower on-hand stock levels will result in a greater opportunity for more staff members to be involved in narcotic security and therefore reduce the likelihood of any narcotic diversion by an individual.
- Question increases in receipted narcotic quantities. When increases are noted, these receipts should be verified against prescriptions and/or with patients and/or physician records to ensure that no diversion is occurring.
- Use inventory trending reports that can alert to changes in pharmacy narcotic ordering and receiving patterns.
- Use pharmacy software that prevents unregulated pharmacy staff from modifying previously entered narcotic prescriptions or processing narcotic prescriptions independently without another regulated pharmacy staff member checking and overriding those transactions.
- Use prescription scanning technology. This technology will allow pharmacists checking prescriptions filled from log or checking refills/part-fills the ability to readily review the original prescription to confirm currency, validity and authenticity.
- Protect individual identifying security devices such as passwords and bar-coded scan cards.
What’s the bottom line?
Get everyone in the pharmacy involved in the security of medications. Don’t have the attitude that narcotic security is the sole responsibility of the pharmacy manager. The more staff involved in all aspects of narcotic security, the less likely that diversion will occur and the more likely that theft will be detected at the earliest opportunity.
Watch for unusual or unexplained trends regarding narcotics in the pharmacy. Follow up on any perceived changes in narcotic ordering patterns, receipts, discrepancies or anything that can not be verified and accounted for. Implement consistently good patient care practices (e.g., having an ongoing dialogue with patients about their use of narcotics and reviewing patient’s medication profiles before checking and dispensing narcotic prescriptions).
Make narcotic security an open and regular part of pharmacy activities in your pharmacy.
Originally published in the April 7, 2009, issue of The Link