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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Article info
Publication history
Published online: February 20, 2019
Accepted:
January 18,
2019
Received:
November 29,
2018
Identification
Copyright
© 2019 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
