Misappropriated medicines

Australian research has recently examined the issue of “misappropriated” medicines in the Emergency Department. The researchers completed a retrospective audit of medications procured and administered (and equipment replaced) during the year 2016, in a tertiary referral ED. Medication procurement data were obtained from the pharmacy dispensing/distribution system and and administration data were harvested from the electronic prescribing system. The medication ‘discrepancy rate’ was defined as the percentage of a medication procured that could not be accounted for by electronic administrations. Discrepancy rates for paracetamol 500 mg and 665 mg tablets were 23.3% and 54.9%, respectively. An intervention to reduce access to the paracetamol/codeine (500/30 mg per tablet) product produced a spectacular reduction in the discrepancy rate for this product from 70.5% (pre-intervention) to 8.8% (post-intervention). Orally administered medications with the potential for misappropriation had high discrepancy rates: caffeine (90.6%), cephalexin 62.9%), ondansetron (50.1%), pantoprazole (42.9%),amoxycillin (41.1%), metaclopramide (41.0%) and the ‘morning after pill’ (levonorgestrel) (36.4%). Aside from obvious economic considerations, theft of scheduled medicines has medication safety implications, emphasizing the need to regularly review and implement remedial actions as needed. The original paper can be viewed here.