In an ASHP Midyear 2023 Clinical Meeting & Exhibition Management Case Study titled “Implementation of Mobile Medication Tracking Technology for Controlled Substance Chain of Custody,” Luning Shi, PharmD, pharmacy administration resident at Houston Methodist Hospital (HMH), explained the limitations of conventional paper-based medication tracking systems for controlled substance diversion prevention. She also described the implementation process of a mobile medication tracking technology in a hospital inpatient pharmacy.
Dr. Shi and her colleagues’ research focused on implementing a Mobile Medication Tracking Technology for controlled substances at HMH. HMH had been using a paper tracking system for controlled substances transition documentation—a system that covered 1,200 inpatient beds, one central pharmacy, and nine satellite pharmacy areas. Dr. Shi explained that her research goal was to “continue to improve and identify any operational gaps throughout the pharmacy areas.”
The Mobile Medication Tracking Technology was implemented to overcome the gaps in the conventional paper-based tracking system, such as difficulties in auditing the process, documentation loss, and illegibility of signatures. Dr. Shi observed that “…there was a gap in transparency and accountability of the controlled substance dispensing process.”
The project was initiated as part of HMH’s Controlled Substance Diversion Prevention Program with the goal of ensuring that 100% controlled substance chain of custody was completed at all transition points of the medication-use process to obtain verifiable accountability.
This study was conducted at HMH’s inpatient pharmacy sterile compounding suite. The study timeframe consisted of 1 month of a preimplementation phase to evaluate the effectiveness of the paper-based tracking system, 4 weeks of a washout period for the transitional process, and 2 months of a postimplementation phase to assess the effectiveness of the mobile medication tracking technology. The implementation process involved 1 week of IT build-out and 3 weeks of training for inpatient pharmacy staff and all inpatient registered nurses. The mobile medication tracking technology went live at all inpatient units of HMH on April 1, 2023. The primary end point was the positive ID capture rate for delivery and receiving personnel. The secondary end point was the controlled substance dispensing to administration time.
During the study period, 209 patient-specific controlled substances were dispensed during the preimplementation phase, and 141 patient-specific controlled substances were dispensed during the postimplementation phase. The paper-based tracking system had 29 missing documents and 64 unidentifiable signatures. During the postimplementation period, 140 out of 141 medications had receiving personnel information documented electronically, with no missing documentation and unidentifiable entries. The medication delivery personnel information capture rate improved from 67.4% to 92.9% (P <.0001) from pre- to postimplementation, respectively. The medication receiving personnel capture rate significantly increased from 44.5% to 99.2 (P <.0001). The study showed a not-statistically significant decrease in the time from medication dispensing to administration, 337.5 minutes preimplementation to 304.5 minutes postimplementation (P = .628).
The results from the postimplementation phase showed that the mobile medication tracking technology significantly enhanced the traceability and accountability of controlled substances. The mobile medication tracking technology can ensure high visibility of the controlled substance chain of custody, effectively minimizing the risk of diversion and increasing the effectiveness of internal controlled substance auditing. The implementation process and study of the mobile medication tracking technology at HMH can serve as a model for other institutions aiming to adopt similar technologies for improvements in controlled substance chain of custody documentation and diversion prevention.
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