The case of the missing medications

Almost one in five, or 19.2%, of medicinal drugs supplied to Melbourne public hospitals go missing, according to research published this week in the Medical Journal of Australia.

The researchers examined the records of medications supplied to specific wards in four Melbourne hospitals (Austin, Box Hill, Footscray and Frankston), and compared this data with the records of medications administered to patients.

“The reason we chose the four hospitals we did was that they each had an electronic medication delivery system and an electronic medical administration system to the patients,” says senior author Professor David Taylor, who has recently retired from directing emergency medicine research at Austin Health.

This isn’t the case for many other hospitals.

“If you don’t have access to electronic delivery and electronic administration, then you really can’t do large scale audits to see exactly what amounts of medications are unaccounted for. Hospitals routinely do it, particularly with drugs that are controlled like oxycodone, but it’s very tedious,” says Taylor.

Even with both electronic systems aligned, it was difficult to establish how much discrepancy there was between medications that were supplied and those that were administered – both because of glitches in the systems, and because hospital staff will often prescribe half or quarter-doses.

The discrepancies between supplied and administered drugs depended on the medication and the ward. Overall, 19.2% of medicines supplied to these wards weren’t registered as administered. Oral antibiotics had the biggest discrepancy, with 86.8% of phenoxymethylpenicillin ordered not being recorded as administered. Discrepancies were larger in general for oral medications, non-controlled medications, and in emergency departments.

In total, the researchers estimated that $27,800 worth of medications were unaccounted for – although they point out that this is small relative to the total costs of medications to hospitals.

“We deliberately did not design this to work out where these medications go and why there were discrepancies,” says Taylor. “That’s a completely different sort of methodology, and quite an involved problem. But I think that needs to happen.”

In the paper, the researchers list a number of potential reasons for these missing medications, and suggest that each should be investigated.

These reasons include theft and self-treatment by medical staff, transfer of medication and patients between wards after hours (particularly from emergency departments to other wards), and failures to document medication.

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Taylor hopes that more hospitals will adopt reliable electronic delivery and administration systems, which will make it easier to track these discrepancies.

“Places like Bunnings do this all the time,” he says.

“Say I bought a spade. That is recorded effectively on the administration side of things: I went along to the cash register and I paid for the spade – it has recorded that the spade has gone out of Bunnings, and so therefore there’ll be an automatic ordering of another spade to make up for the one that I purchased.

“This is what we should be able to do [in hospitals], particularly with medications – because there are ramifications of medications going missing.”

Better electronic management will also allow the researchers to determine whether these discrepancies appear elsewhere in Victoria, and elsewhere in Australia.

“If we can get our electronic systems quite accurate and get repeated, accurate data, then we’ll be able to quantify the extent of the problem,” says Taylor.