What’s inside:

A recent drugs diversion case at an ambulatory surgery center sheds light on critical security lapses in pharmaceutical inventory management. This blog will look into this issue and discuss the security requirements of an automated dispensing cabinet.

Inside:

  • Learn from this case to prevent drugs diversion and safeguard patients and communities.
  • Explore six key security lapses that contributed to the theft of narcotics and controlled drugs
  • Discover how an effective automated dispensing cabinet solution can enhance pharmaceutical inventory security in healthcare facilities.

I’d like to walk through a recent drugs diversion case where a nurse at an Indiana ambulatory surgery center was charged with stealing hundreds of narcotics over a 6-month period.

When decentralized dispensing is carried out in clinical areas, the organization needs to have a strong pharmaceutical inventory management system in place that gives the organization full vision and control of this. An automated dispensing cabinet is a common solution but which security features should providers look out for?

 

Recent drugs diversion case

In this case, the nurse allegedly changed the system so that she was the only one with access to the cabinet, but in the end her drugs discrepancies were discovered.

It turns out the items removed amounted to 300 hydrocodone and acetaminophen pills, 20 Oxycontin pills, 97 Percocet pills, 100 Tramadol pills and 39 vials of fentanyl. In addition, 270 expired Oxycontin pills were not disposed of, as instructed.

The process was for pill counts to be logged at the end of each day, but this task was not undertaken after a few months of her working at the outpatient center.

The center reported that they ended up having to cancel appointments due to a lack of medication.

 

Taking action against drugs diversion

There are so many indicators of poor security and management in this case, that I wanted to go through these and look at how to prevent this situation from occurring at other healthcare facilities.

Drugs diversion cases are always an important reminder of the need for good practice around the management of pharmaceutical inventory in ambulatory surgery centers and other healthcare facilities, so that drugs diversion is prevented and patients, plus the wider community, are protected.

So, let’s go through some of the pharmacy inventory management practices at this surgery center, and take on board some learning points. Here are 6 security lapses that can lead to drugs diversion.

1.      Secure cabinets – system access

At the surgery center the nurse changed the system so that she was the only person with access to the cabinet. This in itself should have raised eyebrows, and it was this action that prevented the issue from being discovered earlier – it took around 6 months for her drugs theft to be discovered.

Security access: There is no security issue in having multiple users, as a good system ensures everyone accessing the system goes through security steps to authenticate them as a user, before being allowed entry into the system. Users can be identified and authorized using biometrics, face recognition, passwords or card swipes.

Drugs access: Access to a full cabinet of pharmaceutical stock should not be made possible. User access should be limited to only those items entered into the system against a specific patient.

Security solution:

Single cell dispensing is an excellent method of controlling user access to just those items logged for dispensing. This system not only limits access to a particular drug, but also ensures the dosage required is the only dosage they are given access too. Single cell dispensing offers the greatest flexibility in terms of providing access to the exact drug, in the requested quantity and not allowing users to take any other item.

Pharmaceutical inventory requires strong process and robust security. A top quality automated dispensing cabinet with built-in security features that prevent drugs diversion, can provide stringent safeguards.

 

User identification security features such as biometric fingerprints, face recognition ensure restricted access to authorized personnel only.
User identification security features such as biometric fingerprints, face recognition ensure restricted access to authorized personnel only.

 

 

2.      Narcotics cabinet – visibility of controlled drugs and narcotics

Best practice is for cabinets to have oversight from both pharmacy and clinical contacts – so that full and real-time visibility of stock-levels and dispensing records are available.

Both types of users have different roles.

  • Pharmacist inventory management: Pharmacists need to view the stock to monitor expiry, ensure prompt restocking of items that are in short supply, and monitor clinician usage.
  • Clinicianal dispensing: Clinicians need to be able to dispense drugs for patients, digitally recording the items that are given to each patient.

 

Visibility solution:

A good automated dispensing system for decentralized dispending will have dual access and system functionality that facilitates pharmacy management and clinician dispensing.

It is important that when clinician-led dispensing is practiced by healthcare providers, that the pharmacy retains an active management role. It is ultimately the Pharmacy Department that retains responsibility for all controlled drugs, narcotics and medication that is dispensed at the point of care – so the automated dispensing cabinet used must ensure full pharmaceutical vision and control.

 

3.      Automatic dispensing – user tracking

Modern automated dispensing cabinets ensure that all individual users have all their drugs cabinet activity digitally tracked. That means every action is logged in the system, dosages and drugs dispensed, returns and wastage activity.

This digital tracking ensures full user accountability and helps organizations to spot suspicious activity at the earliest opportunity.

User tracking solution:

Tracking the activity of every user is vital to ensure full oversight of user activity and is an important step in deterring drugs diversion activity.

Automated dispensing cabinets need to digitally track every action of each user.

 

4.     Medication dispensing – item tracking

Every drug dispensed, including the exact dosage, needs to be digitally logged against the patient, the case and the dispensing clinician.

This not only helps the pharmacy department with item-level consumption tracking, for informed procurement, but it also ensures that the medical records for the case are complete and correct.

In addition, returns and wastage should also be tracked, not just usage. This is critical.

Many systems have a general pharmacy returns bin or drawer, so not only can the details of which clinician returned which drug, in what quantity, for which patient all be unclear, but you may also be giving clinical staff access to the returned items of others.

Returns work best when the are individually tracked using a single cell returns method. Wasted drugs also need to be reconciled on the system. Ultimately the pharmacist needs to understand what happened to every item removed from the cabinet whether it was fully used, partially used, wasted or returned.

Drugs tracking solution:

The best automated dispensing cabinets track every item with this degree of detail, and it is this strong control that makes diverting drugs so much more difficult.

Digital, item-level tracking is an important feature of any automated dispending cabinet. Look out for systems that are interoperable with hospital software, such as the ERP and EHR, for maximum impact.

Locked drawers and single cell dispensing ensures secure, item-level tracking.
Locked drawers and single cell dispensing ensures secure, item-level tracking.

5.      Decentralized automated dispensing devices and expiry management

In the drugs diversion case at the Indiana surgery center, it was reported that 270 expired items were not disposed of, as requested.

This is another indicator of poor process.

❔ Why had 270 items expired and not been used?

❔ Were the items ordered when there was little demand for them?

❔ Was the stock poorly rotated so that items ended up being wasted rather than used?

❔ Why if the expiry order was given, was it not followed up sooner?

❔Were expired items promptly removed from the cabinet to avoid accidental usage?

❔Were checks made to ensure the items were properly disposed of and recorded as such in the system?

 

Expiry management is a patient safety and compliance issue. Processes need to ensure the prompt removal and disposal of expired drugs and medication as per the hospital’s protocols.

Expiry management solution:

Pharmaceutical expiry management needs very careful oversight. Pharmacists need to monitor their inventory, rotate stock, and endeavor to prioritize the usage of items that are due to expire.

Expired items are a patient safety risk and must be easily identified and removed from the cabinet if patient safety standards and regulatory compliance is to be upheld.

But more than this, proactive expiry management should ensure all items are used prior to expiry, preventing them from expiring on the shelves, representing significant wasted costs and preventing patients from the risk of dispensing unsafe items.

 

6.      Automated drug dispensing system – drug shortages and stockouts

The Indiana outpatients center reportedly ended up having to cancel patient appointments due to medication stockouts.

Pharmacy procurement solution:

An automated dispensing cabinet should effectively monitor all drugs dispensing activity, with real-time usage figures informing procurement, and preventing delays.

With single cell, precise digital tracking of usage, wastage and returns there is total clarity on dispensing and demand-driven restocking can be achieved, preventing surpluses,

When procurement is proactive shortages and stockouts can be prevented, so that no patient has a cancelled appointment, risking their wellbeing.

 

Narcotics Cabinet
IDENTI’s Secured Narcotics, Drugs and Medications Cabinet with secure, single cell dispensing

 

Diversion management – preventing drugs diversion in healthcare

The recent drugs diversion case in Indiana underscores the importance of robust security measures in pharmaceutical inventory management.

By addressing key security lapses and implementing effective and automated pharmacy dispensing machines, healthcare facilities can prevent theft and diversion of controlled drugs, ensuring patient safety and regulatory compliance.

Check out IDENTI’s Secured Narcotics, Drugs and Medication Cabinet for comprehensive security solutions tailored to decentralized dispensing settings. This advanced automated dispensing cabinet contains ALL the security solutions we’ve covered in this article and is custom designed for decentralized dispending in operating rooms, procedural areas and community health setting.

Get in touch to find out how you can gain full control of your pharmaceutical inventory.

FAQ: Automated Dispensing Cabinet Risks: 6 Security Lapses Exposed

Pharmaceutical inventory needs careful supervision at the clinical and pharmaceutical levels.

Automated dispensing machines in hospitals, ambulatory surgery centers and community health centers are now playing a key role in ensuring full security and oversight of controlled drugs, narcotics and medications.

An automated dispensing cabinet should have the following security features:

  • Implement robust authentication processes for all users accessing the system.
  • Locked drawers to prevent unauthorized access
  • Utilize single cell dispensing to limit access to specific drugs and dosages.

Investing in automated dispensing cabinet that has built-in security features can prevent drugs diversion.

Full visibility of controlled drugs, medications and narcotics is vital for efficient and effective management of this high-risk inventory.

  • Real-time oversight of stock levels and dispensing records helps prevent theft and diversion.
  • Effective management begins with real-time vision of supply levels and consumption.
  • Real-time stock visibility enables the Pharmacy Department to monitor usage, expiry dates, and ensure demand-driven restocks.

 

In today’s healthcare environment there should be no need for inefficient and risky manual stock counts, all types of automated dispensing systems should provide the full stock visibility you need.

User tracking is an important security feature in automated medication dispensing systems, and when users have knowledge of the tracking abilities of a system this can prevent unlawful activity from occurring in the first place.

  • Digital tracking of user activity ensures personal accountability and early detection of suspicious behavior.
  • Automated dispensing cabinets should log every action of each user for comprehensive oversight.

 

User tracking ensures a digital record of every action taken by each user.

Item-level tracking is vital for managers to understand the current levels and movement of their pharmaceutical supplies.

  • Item-level tracking facilitates consumption monitoring, procurement decisions, and patient safety.
  • Systems with locked drawers and single cell dispensing features ensure secure, accurate tracking of medications.
  • Ensuring system interoperability with hospital software ensures vital data can be shared with patient records, pharmacy procurement systems and more.

Stock monitoring and control is vital for pharmaceutical inventory management

  • Proactive expiry management includes monitoring inventory, rotating stock, and prioritizing usage.
  • Real-time usage data informs procurement, preventing delays, surpluses, and stockouts.
  • Hands-on, proactive expiry management prevents the unnecessary wastage of stock by prioritizing usage of soonest-to-expire products

 

When the hospital Pharmacy Department has full vision of their decentralized dispensing stock they are able to control and optimize their inventory while protecting patients and reducing costs.

Let’s look at some of the indicators that there is a drugs diversion issue at a healthcare facility.

  • Unexplained discrepancies in drug inventory records.
  • Patterns of medication administration inconsistent with patient needs.
  • Behavioral changes or unusual activities among healthcare staff, such as frequent unexplained absences or financial difficulties.
  • Patient complaints about inadequate pain management or unexpected adverse reactions to medications.

 

Automated dispensing systems are an excellent tool for highlighting some of these issues, ensuring quicker action can be taken and reduding risk.

Decentralized dispensing refers to the distribution of medications and controlled substances from automated dispensing cabinets located in clinical areas, such as operating rooms, procedural areas, patient care units and community healthcare facilities.

Unlike traditional centralized pharmacy models where medications are dispensed from a central pharmacy location, decentralized dispensing brings medications closer to the point of care, improving efficiency and patient access to necessary medications.

 

When an organization is looking to commence decentralized dispensing, it is important to review security and consider using an automated dispensing cabinet that enables the Pharmacy Department to retain full control.

  • Enhanced patient care: Decentralized dispensing allows clinicians to access medications quickly, reducing wait times and improving patient outcomes.
  • Increased efficiency: By placing automated dispensing cabinets in clinical areas, healthcare facilities streamline medication distribution processes, reducing the time and resources required for medication delivery.
  • Improved medication management: Real-time tracking and monitoring of medication usage enable better inventory control, minimizing stockouts, reducing waste, and preventing drugs diversion.
  • Enhanced security: Automated dispensing cabinets equipped with advanced security features, such as biometric authentication and digital tracking, ensure secure access and accountability, reducing the risk of medication errors and theft.

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About the author

Or is the Head of Marketing and Strategic Partnerships. She has a wealth of experience in the health–tech sector. Her innovative marketing strategies have successfully driven IDENTI’s growth in multiple worldwide markets. Her strength is the ability to identify what truly resonates within the industry. She is passionate about building relationships and her expertise lies in creating meaningful partnerships with healthcare providers, distributors, and suppliers..

Pharmaceutical inventory needs careful supervision at the clinical and pharmaceutical levels.

Automated dispensing machines in hospitals, ambulatory surgery centers and community health centers are now playing a key role in ensuring full security and oversight of controlled drugs, narcotics and medications.

An automated dispensing cabinet should have the following security features:

  • Implement robust authentication processes for all users accessing the system.
  • Locked drawers to prevent unauthorized access
  • Utilize single cell dispensing to limit access to specific drugs and dosages.

Investing in automated dispensing cabinet that has built-in security features can prevent drugs diversion.

Full visibility of controlled drugs, medications and narcotics is vital for efficient and effective management of this high-risk inventory.

  • Real-time oversight of stock levels and dispensing records helps prevent theft and diversion.
  • Effective management begins with real-time vision of supply levels and consumption.
  • Real-time stock visibility enables the Pharmacy Department to monitor usage, expiry dates, and ensure demand-driven restocks.

 

In today’s healthcare environment there should be no need for inefficient and risky manual stock counts, all types of automated dispensing systems should provide the full stock visibility you need.

User tracking is an important security feature in automated medication dispensing systems, and when users have knowledge of the tracking abilities of a system this can prevent unlawful activity from occurring in the first place.

  • Digital tracking of user activity ensures personal accountability and early detection of suspicious behavior.
  • Automated dispensing cabinets should log every action of each user for comprehensive oversight.

 

User tracking ensures a digital record of every action taken by each user.

Item-level tracking is vital for managers to understand the current levels and movement of their pharmaceutical supplies.

  • Item-level tracking facilitates consumption monitoring, procurement decisions, and patient safety.
  • Systems with locked drawers and single cell dispensing features ensure secure, accurate tracking of medications.
  • Ensuring system interoperability with hospital software ensures vital data can be shared with patient records, pharmacy procurement systems and more.

Stock monitoring and control is vital for pharmaceutical inventory management

  • Proactive expiry management includes monitoring inventory, rotating stock, and prioritizing usage.
  • Real-time usage data informs procurement, preventing delays, surpluses, and stockouts.
  • Hands-on, proactive expiry management prevents the unnecessary wastage of stock by prioritizing usage of soonest-to-expire products

 

When the hospital Pharmacy Department has full vision of their decentralized dispensing stock they are able to control and optimize their inventory while protecting patients and reducing costs.

Let’s look at some of the indicators that there is a drugs diversion issue at a healthcare facility.

  • Unexplained discrepancies in drug inventory records.
  • Patterns of medication administration inconsistent with patient needs.
  • Behavioral changes or unusual activities among healthcare staff, such as frequent unexplained absences or financial difficulties.
  • Patient complaints about inadequate pain management or unexpected adverse reactions to medications.

 

Automated dispensing systems are an excellent tool for highlighting some of these issues, ensuring quicker action can be taken and reduding risk.

Decentralized dispensing refers to the distribution of medications and controlled substances from automated dispensing cabinets located in clinical areas, such as operating rooms, procedural areas, patient care units and community healthcare facilities.

Unlike traditional centralized pharmacy models where medications are dispensed from a central pharmacy location, decentralized dispensing brings medications closer to the point of care, improving efficiency and patient access to necessary medications.

 

When an organization is looking to commence decentralized dispensing, it is important to review security and consider using an automated dispensing cabinet that enables the Pharmacy Department to retain full control.

  • Enhanced patient care: Decentralized dispensing allows clinicians to access medications quickly, reducing wait times and improving patient outcomes.
  • Increased efficiency: By placing automated dispensing cabinets in clinical areas, healthcare facilities streamline medication distribution processes, reducing the time and resources required for medication delivery.
  • Improved medication management: Real-time tracking and monitoring of medication usage enable better inventory control, minimizing stockouts, reducing waste, and preventing drugs diversion.
  • Enhanced security: Automated dispensing cabinets equipped with advanced security features, such as biometric authentication and digital tracking, ensure secure access and accountability, reducing the risk of medication errors and theft.
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