“Considerable quantities of medications are not accounted for in public hospitals,” Taylor and colleagues wrote after examining the medication supply and administration data for 20 frequently used medications.
The four hospitals examined in the study were Austin, Box Hill, Footscray and Frankston Hospital in Melbourne, Victoria, with an estimated overall cost of the missing medication to be around $27,000; around 0.02 percent of the 2019 medication budget of $124,979,795 for the included wards in the four hospitals.
The drugs they analysed fell into the four broad categories of antibiotics, gastrointestinal medications, benzodiazepines, an antidepressant, and analgesics.
Of the unaccounted-for medication, the discrepancy was higher for medication useful for self-treatment, with oral medication such as antibiotics and gastrointestinal medication ranking the highest.
Around 86.8 percent of phenoxymethylpenicillin in 250 mg capsules, a form of oral antibiotics, were not administrated.
53.3 percent of ondansetron in 4 mg tablets, used as a gastrointestinal medication, were also missing.
The authors reasoned that the high discrepancy in oral medications might be due to staff members taking the drugs for self-treatment. In contrast, non-oral treatments had lower discrepancy rates, so this may be due to wastage.
Across wards, discrepancies were the highest for emergency departments, with a rate of 32.3 percent as opposed to 16.0 and 12.1 percent for medical and surgical wards, respectfully.
The authors were glad to see that controlled medication that can lead to dependence had low discrepancy rates; however individual hospitals had higher rates for oxycodone, an opioid and temazepam, often used to treat insomnia which may require further studies.
Reasons for the discrepancies were not examined, but the authors suggested that “medication discrepancies are partially explained by theft, typically for self-treatment,” especially for oral treatments.
Taylor and his colleagues reasoned that the high discrepancy rates for EDs could be due to medications often being transferred from EDs to other wards and services. Transfers may bypass the supply and administration systems, especially when out of regular work hours.
“Patients discharged to hospital in the home may be given parenteral medications to ensure continuity of treatment before a definitive source is secured, and doctors may provide discharged patients with starter packs or complete courses of medication instead of prescriptions,” the authors wrote.
“The relatively hectic environment and larger staff numbers in EDs may also contribute to discrepancies.”
Other possible explanations for discrepancies include failure to document medication administration and verbal orders, the medication record system may also be down temporarily as well as administrative errors. Changes in supply medication levels, stock recalls, spillage, waste, and medication expiry are also possible reasons for the discrepancies.
However, Taylor and his co-authors concluded that discrepancy rates of around 20 percent are “clinically significant” and recommended interventions to be put in place.
“We recommend that the integrity of electronic medication supply and administration data be validated, comparing electronic with manual audit data,” the authors stated.
“Cameras in medication rooms could be considered, and procedures for averting diversion and harmonising supply and use reviewed.”
The journal concluded that reasons for the discrepancies should be examined for the development of appropriate interventions, which includes staff education, strict administration procedure and audits, improved tracking of medication transferred to hospital wards, to patients or other services and also when it is not used for whatever reasons.
