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YELLOW SHEET Office of the State Auditor of Missouri |
July 20, 2001
Report No. 2001-55
Better management of pharmacies at state psychiatric service facilities
could curb the risk of missing, misused or stolen drugs
This audit
reviewed how state-operated psychiatric service facilities manage drugs
disbursed to patients.� The review
focused on the 10 state facilities run by the Department of Mental Health�s
Division of Comprehensive Psychiatric Services and its internal controls over
drug dispensation, inventories, formularies and pharmacy stocks.� To test drug management, the audit tracked
the drug dispensation from pharmacy to patient in about 60 instances at each
facility.� The following highlights the
audit�s findings:
Drugs records:
some missing, others had discrepancies
The audit found
instances at three facilities in which staff could not locate portions of
patient medical records or controlled substance records.� One facility could not find two weeks of
daily controlled substance inventory records at two wards.� In reconstructing some of these records, the
audit staff found shortages of drugs, such as Valium, Ativan and Tylenol No.
3.� Audit tests could not pinpoint what
happened to these drugs.� In addition,
audit tests showed 15 instances in five facilities where pharmacy records
showed one drug dosage charged to a patient, but patient records do not show if
they received or refused the drug.� (See
page 4)
Overstocked
pharmacies show need for better drug inventory
Several facilities
overstocked pharmacies at the end of the fiscal year to increase reserves of
high cost and frequently prescribed drugs.�
One facility made 77 percent of its drug expenditures in the last two
months of fiscal year 2000, which left enough of some drugs to last more than
two years.� The overstocking seemed
unnecessary since the prime drug vendor delivers within two days of an
order.� In addition, if the drugs
expired from non-use, the state would pay 10 percent of the drug cost to return
drugs purchased more three months prior.�
(See page 10)
Better drug
formularies could control drug expenditures
Drug formularies,
which are continually updated lists of approved medications, promote optimal
patient care.� The state does not
require psychiatric facilities to maintain drug formularies.� And of the seven facilities that have
developed formularies, many are too broad.�
One facility had 14 drugs on its list to treat depression and 12 to
treat psychosis, but some of these drugs were seldom or never used. �Each facility had one or more drugs for
either depression or psychosis that had fewer than 100 units dispensed over the
fiscal year 2000.� In addition, drugs
dispensed at places without drug formularies are not properly
controlled or tracked.� (See page 15)
