You are invited to participate in a pilot project to design and test a methodology for a large-scale study to determine the value of periodic physical inventory of ADCs. Please contact Colleen Connelly firstname.lastname@example.org or Maureen Burger email@example.com for questions or additional information.
To design and test a method to measure the output (number of discrepancies) detected during routine periodic physical inventory of ADCs during a six-month period. Recruiting partners with any ADC system, e.g., BD, Omnicell and Cerner.
The counting of controlled substances has been an essential nursing practice since the introduction of the Controlled Substances Act of 1970, and many nursing hours have been devoted to counting controlled substance in an effort to control and mitigate diversion.
Automated Dispensing Cabinets (ADCs) are now widely used by hospitals as part of the effort to maintain accurate narcotic counts. ADCs create and store electronic records of every narcotic transaction. Periodic physical inventory of each ADC is still considered a best practice to support early detection and investigation of diversion.The frequency and format for periodic physical inventory varies widely, from weekly to monthly or never.
Since ADC technology provides real-time information about narcotic transactions, including product, user, patient, time and date, it is unclear whether the physical inventory of narcotics is also a worthwhile use of precious nursing resources. This is particularly important to consider as nurses are inundated with an increasingly long list of tasks to complete each day.
There is scarce data available to show whether or not periodic physical ADC inventory impacts diversion detection. A systematic literature review of ADCs, bar-coded medication administration and electronic medication management systems found only 11 studies that examined the impact of ADCs. However, one study noted, “discrepancies could go unnoticed and left unaddressed for extended periods of time because the hospital pharmacy was short-staffed and unable to deal with ADC discrepancy reports.”Are unnoticed discrepancies due to short-staffing a problem today, or are discrepancies appropriately and timely resolved?
Nolan and colleagues conducted a Failure Modes and Effects Analysis to identify potential sources of controlled substance diversion and develop solutions. Two failure modes were identified with physical counts, including tampering or replacing controlled substances and fabricating discrepancies. The results suggests that an opportunity for discrepancy is created every time a drawer is opened and counted. In other words, periodic physical inventory could actually increase the risk for diversion.
 Zheng W, Lichtner V, Van Dort BA, Baysari MT. The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: A systematic review. 2021. Research in Social and Administrative Pharmacy; 17; 832–841. https://doi.org/10.1016/j.sapharm.2020.08.001
 Balka E, Kahnamoui N, Nutland K. Who is in charge of patient safety? Work practice, work processes and utopian views of automatic drug dispensing systems. 2007. Int J Med Inform 7; 6 S, S48–S57. https://doi.org/10.1016/j.ijmedinf.2006.05.038
 Nolan K, Zullo AR, Bosco E, Marchese C, Berard-Collins C. Controlled substance diversion in health systems: A failure modes and effects analysis for prevention. 2019. AJHP; 76:1158-1164. https://doi.org/10.1093/ajhp/zxz116