WHSCT audit uncoversdrugs failings

AN internal audit completed in March, 2010 revealed serious concerns over the ordering and checking of pharmacy items in three wards at Altnagelvin Hospital. The results of the audit also pinpointed concerns of unauthorised access to and the possible theft of drugs being delivered onto the wards.

The audit document was obtained by the Londonderry Sentinel under the Freedom of Information Act and is entitled: “Western Health and Social Care Trust-Review of Systems for the Ordering and Receipt of Pharmacy Items at Ward Level 2009/10.”

The audit was completed by the Internal Audit Unit in Londonderry and was issued to the Western Health and Social Care Trust (WHSCT) on March 3, 2010.

The internal examination was initiated in November 2009 at the request of the Head of Pharmacy and Medicines Management and concentrated on a review of the systems for ordering and receipt of pharmacy items at ward level.

A sample of six wards across the Trust were chosen for the review including two at the Erne Hospital and one at the Tyrone County Hospital in Omagh. The three remaining wards chosen for the audit process were Wards 3, 42 and 43 at Altnagelvin Hospital.

The auditors visited the wards under scrutiny and interviewed staff responsible for the ordering and receipt of pharmacy items. The audit did not examine the the ordering and receipt of controlled drugs as separate procedures are in place for those.

Results of the audit revealed that at Wards 42 and 43 at Altnagelvin “there was an absence of physical checking of pharmacy items received to order documentation.”

The results also revealed that all three wards scrutinised at Altnagelvin “non-stock items received are not checked to order documentation.”

The internal check also raised concerns over the lack of segregation of duties with regard to the ordering and receipt of stock items at Wards 3 and 42 in Altnagelvin. The audit said: “In both instances a pharmacy support worker was solely responsible for all aspects of the ordering and receipt process.”

The auditors also raised concerns over unapproved access and or the theft of drugs within Altnagelvin. The reports states: “Drugs ordered at the 3 Altnagelvin Wards were delivered in either pouches or boxes. It was noted that while the boxes are sealed when they arrive at wards, in a number of cases, the clips used to seal the pouches were broken and they were not sealed.

“There is a risk therefore of unauthorised access/misappropriation by the person delivering the drugs to wards and the lack of physical checks of drugs received at the wards means that this may go undetected.”

The report also noted that staff from all three Altnagelvin wards that were audited were using the incorrect stationery to requisition and receive non-stock items from the pharmacy. Those interviewed during the audit process advised that the correct non-stock order books had not been available for a “few months”.

The audit report stated: “The use of inappropriate stationery for ordering non-stock items form Pharmacy may reduce the effectiveness of controls over the authorisation of orders.”

The auditors recommendations on the findings said staff that took delivery of pharmacy orders should check the received items to the order documentation and that these forms should be signed and dated as evidence the orders had been checked and to leave an audit trail. Of the above the recommendations said: “Where discrepancies occur, these should be fully investigated and resolved.”

The audit recommendations also confirmed that a pharmacy support worker was responsible for all aspects of the stock ordering and receipt process at Wards 3 and 42 in Altnagelvin.

“Consideration,” the report said, “should be given to involving ward nursing staff in the process in order to introduce an element of checking e.g. nursing staff should check items received to the order documentation before the items are stored away.”

The audit also recommended that all drugs sent to wards from pharmacy should be sent in sealed containers and the Trust should consider whether the responsibility for delivering drugs to wards should be restricted to Pharmacy and / or ward staff only. Furthermore, the report recommended that appropriate non-stock acquisition books should be obtained and issued to staff as required.

The failure to have ‘proper’ requisition documentation was later blamed on the receipt of an incorrect stationery order from a North West printing firm.

The report also said that two members of Pharmacy staff are always involved in the ordering and picking process. It continued: “We will ask ward managers to sign for receipt of orders on the Altnagelvin site indicating that the volume and range of products listed is reasonable. In addition, ward managers will be sent monthly print-outs of all all goods sent from Pharmacy to allow them to monitor usage trends. This will be followed up formally by the ward pharmacist (where one is in post).”

Finally, the audit recommended that all the pouches and containers in use be examined to ensure they are sealable and that staff be reminded to ensure all containers are sealed before they leave the Pharmacy department.

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