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Misappropriation of medications and equipment in the emergency department

Published:February 20, 2019DOI:https://doi.org/10.1016/j.auec.2019.01.005

      Abstract

      Objective

      To determine the nature and extent of misappropriation of medications and equipment from the ED.

      Methods

      We undertook a retrospective audit of medications procured and administered, and equipment replaced, in 2016, within a tertiary referral ED. Medication procurement and administration data were obtained from our MERLIN® pharmacy system and CERNER® electronic prescribing system, respectively. A medication ‘discrepancy rate’ was defined as the percentage of a medication procured that could not be accounted for by electronic administrations. The study also comprised a nested intervention sub-study where, from July 1, 2016, all Panadeine Forte tablets were stored in a locked facility. Victorian Hospital Healthcare Equipment invoices were audited to determine which major non-disposable equipment items most commonly needed resupply.

      Results

      Discrepancy rates for paracetamol 500 mg and 665 mg tablets were 23.3% and 54.9%, respectively. Following the Panadeine Forte intervention, the discrepancy rate for this medication fell from 70.5% to 8.8%. Orally administered medications with the potential for misappropriation had high discrepancy rates: caffeine (90.6%), cephalexin (62.9%), ondansetron (50.1%), pantoprazole (42.9%), amoxicillin (41.1%), metoclopramide (41.0%) and the ‘morning after pill’ (levonorgestrel) (36.4%). Parenterally administered medications had lower discrepancy rates: ceftriaxone (7.9%) and ampicillin (3.4%). The largest equipment replacement rates were for tourniquets and crutches.

      Conclusion

      Discrepancy rates for many medications, especially those administered orally, are high. Further research is required to determine how these medications ‘go missing’. Placing a medication with a high discrepancy rate in a locked facility with a ‘logbook’ substantially reduces this rate. Misappropriation of non-disposable equipment items is uncommon.

      Keywords

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