Medication Audit

Work on chemical restraints made me aware that Margaret was taking two other medications on a daily basis as well as the one on an as-needed basis.

This purchase audit, that anyone can do, draws from the pharmacist and insurance records (which are identical). The audit is adequate to determine that the right number of pills is being purchased. 

During Margaret's 50-year carrier as a surgical nurse, it seemed that more people lost their licenses from diverting patient prescriptions than about anything else.

This (and errors in the system) has led to a new business that packages pills, by the patient and by the time of day, in bubble packs. Currently a computer program announces when to dispense the pills. The bubble packs are made in St. Louise and installed in the medication carts by the same company. 

All of this work is paid for, in part, by salvaging pills that are not dispensed and by changing from a 3-month supply co-pay to billing on a 1-month supply co-pay. We were not accepted by the new system.

Our pills are still ordered and dispensed the old fashion way. I drive one mile to the pharmacy our insurance uses. We have used this store for over 10 years.

Therefore the rate of use is affected by how soon a refill is requested. Both Sertraline (Zolft) for depression and social anxiety disorder and Sotalol for heart rhythm are taken daily.

The charts show the rate of use from one purchase to the next purchase. In general, the rate of use is below one/day as new orders and refills are, in general, made when the last pill in the bottle is used. This system has been used many many years by long term care facilities.

We always reordered or refilled before we ran out before moving into memory care. That happened only once here at Provision Living in 2018, producing a usage rate over one  per day for Sotalol.

At least 11 bottles of pills should have been purchased in 2018 for each medication. That did not happen. Only 9 bottles were purchased. 

Margaret may have refused to receive her daily pill. The facility records would show this. The pill may have been returned to the bottle.

She may have refused the pill, but it was not put back into the bottle. Most of her pills are now taken with a carrier that changes the flavor: yogurt, pudding, ice cream, etc. These can not be put back into the bottle. (Assisted living residents often comment on the terrible taste of their pills and what they use to help take them.)

This audit shows no excess purchase of pills, in fact, it suggests an alternative source. A copy of the pill passing record would be needed to actually know what happened each day. The bubble packs are designed for a more accurate system.