Narcotics for P.E.I. government manors 'not adequately controlled,' AG says

Health PEI is not disposing of unused narcotics and other controlled drugs as required under federal legislation, P.E.I.'s auditor general has concluded.

In a review looking at oversight of narcotics and other controlled drugs sent to the province's 10 government-owned long-term care facilities, Auditor General Jane MacAdam concluded that oversight is lacking.

Diversion could remain undetected.- Auditor General Jane MacAdam

"Overall, we concluded that narcotics and controlled drugs for residents of provincially-owned long-term care facilities were not adequately controlled," MacAdam wrote.

In particular, she found P.E.I.'s provincial pharmacy does not maintain records of unused narcotics and other controlled drugs held for disposal, as required under federal legislation.

"Without these records, there is an increased risk that any diversion could remain undetected," she wrote.

She also noted that, while Health PEI has contracted a third party to dispose of unused narcotics, "the contractor is not a licensed dealer in accordance with the terms set out by Health Canada."

Provincial pharmacy's monitoring ability limited

When a resident at a long-term care facility was discharged leaving behind unused narcotics, MacAdam found, those drugs were only returned to the provincial pharmacy six out of 27 times.

In most cases, she said control sheets indicated the drugs had been administered to another patient at the facility.

"This practice limits the provincial pharmacy's ability to monitor the use of narcotics and increases the risk to patient safety for example where the drug is administered to another resident," MacAdam wrote.

She also said this and a number of other practices increase the risk that narcotics and other controlled drugs could go missing from the system without being detected.

MacAdam said some inventory controls are inadequate, while other control measures, including electronic logins required for inventory management software, were not being used as intended.

Some of the other findings in the report:

• Only seven of 12 monthly counts of narcotics were conducted at P.E.I.'s provincial pharmacy, which distributes prescription drugs to the 10 long-term care facilities.
• No monthly counts were conducted of benzodiazepines, a controlled drug.
• Annual inventory counts of controlled drugs were not signed and dated indicating who conducted the count and when it was performed.
• There were no procedures to account for all narcotics and narcotics control sheets issued by the provincial pharmacy. Five per cent of control sheets requested during the audit could not be located by staff.
• At one long-term care facility, reconciliations of narcotics on-site did not include actual numbers, only signatures confirming the counts had taken place.

The auditor general also raised concerns about manual adjustments made to electronic inventory records at the provincial pharmacy, calling these adjustments a "high-risk" area. She said out of 45 adjustments for which supporting documentation was requested, that documentation could not be provided in three cases.

"The control weaknesses identified at the provincial pharmacy provide the opportunity for unidentified diversion," she concluded.

While MacAdam said she was advised that management does not routinely investigate adjustments for inventory shortages, she also found it would be "difficult to identify and assign responsibility should an incident occur," because multiple staff members regularly access the inventory control system using the same login information.

In an email to CBC News, a spokesperson for Health PEI said the agencyhas already taken steps "to address the disposal of narcotics and controlled pharmaceuticals, ensuring that we disposes of all pharmaceuticals in accordance with applicable provincial and federal legislation."

Health PEI says it's also begun working on an "automated dispensing cabinet project to improve security and tracking of medications."

The agency said it has taken or plans to take action on all of the auditor general's recommendations, with plans already in place to address the majority of those recommendations within the next few months.

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