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Title: Misappropriation of medications and equipment in the emergency department.
Austin Authors: Hendarto, Andreas;Harding, Andrew M ;Kant, Joyce A;Hunter, Michelle T;Taylor, David McD 
Affiliation: Department of Medicine and Radiology, University of Melbourne, Parkville, Victoria 3052, Australia
Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
Bairnsdale Regional Health Service, Bairnsdale, Victoria 3875, Australia
Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia
Eastern Health, 5 Arnold St, Box Hill, Victoria 3128, Australia
Issue Date: Jun-2019 2019-02-20
Publication information: Australasian emergency care 2019; 22(2): 92-96
Abstract: To determine the nature and extent of misappropriation of medications and equipment from the ED. 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. Discrepancy rates for paracetamol 500mg and 665mg 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. 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.
DOI: 10.1016/j.auec.2019.01.005
ORCID: 0000-0003-3992-7316
PubMed URL: 31042528
Type: Journal Article
Subjects: Diversion
Emergency department
Medication abuse
Appears in Collections:Journal articles

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